|
pop ACH RECP MUSCLE BINDING AB
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
pop achr ganglionic neuronal ab
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
pop achr ganglionic neuronal ab
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
pop acid fast culture
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
2200505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$19.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: GEHA Medicare |
$10.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$11.88
|
| Rate for Payer: Humana Medicare Advantage |
$10.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.80
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.36
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.60
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.58
|
| Rate for Payer: United Healthcare Commercial |
$184.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.80
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Medicare |
$9.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.96
|
| Rate for Payer: Zelis Worker's Compensation |
$13.49
|
|
|
pop acid fast culture
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
2200505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$19.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$13.49
|
|
|
pop adalimumab drug level
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2200668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
pop adalimumab drug level
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2200668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$14.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$15.53
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.12
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.00
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.24
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.84
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.12
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.94
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
pop aerobic cs bodyfluid
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2200711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: GEHA Medicare |
$8.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$9.48
|
| Rate for Payer: Humana Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.62
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.65
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.24
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.45
|
| Rate for Payer: United Healthcare Commercial |
$234.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.62
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Medicare |
$7.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.34
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
pop aerobic cs bodyfluid
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2200711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
pop amino acids 306266 REF
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 82131
|
| Hospital Charge Code |
2201003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$41.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$41.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$22.98
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: First Health Commercial |
$270.00
|
| Rate for Payer: First Health Workers Compensation |
$41.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.00
|
| Rate for Payer: GEHA Commercial |
$240.00
|
| Rate for Payer: GEHA Medicare |
$22.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.00
|
| Rate for Payer: Humana ChoiceCare |
$25.28
|
| Rate for Payer: Humana Medicare Advantage |
$22.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$38.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$33.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$22.98
|
| Rate for Payer: Multiplan All |
$273.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.07
|
| Rate for Payer: OMNI Networks Commercial |
$210.00
|
| Rate for Payer: One Health Plan PPO/POS |
$270.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$33.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$22.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$45.96
|
| Rate for Payer: Three Rivers Provider Network All |
$225.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.52
|
| Rate for Payer: United Healthcare Commercial |
$255.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$22.98
|
| Rate for Payer: Zelis Auto |
$120.00
|
| Rate for Payer: Zelis Medicare |
$19.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.58
|
| Rate for Payer: Zelis Worker's Compensation |
$29.69
|
|
|
pop amino acids 306266 REF
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 82131
|
| Hospital Charge Code |
2201003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: First Health Commercial |
$270.00
|
| Rate for Payer: First Health Workers Compensation |
$41.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.00
|
| Rate for Payer: GEHA Commercial |
$210.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.00
|
| Rate for Payer: Multiplan All |
$273.00
|
| Rate for Payer: OMNI Networks Commercial |
$210.00
|
| Rate for Payer: One Health Plan PPO/POS |
$270.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$225.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.00
|
| Rate for Payer: Zelis Auto |
$120.00
|
| Rate for Payer: Zelis Worker's Compensation |
$29.69
|
|
|
pop ammonium ua 306266
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
2201004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$27.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.74
|
|
|
pop ammonium ua 306266
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
2201004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$27.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$14.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$16.03
|
| Rate for Payer: Humana Medicare Advantage |
$14.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.57
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.77
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.14
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.28
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.57
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$12.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.48
|
| Rate for Payer: Zelis Worker's Compensation |
$19.74
|
|
|
pop amphiphysin ab
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2299520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
pop amphiphysin ab
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2299520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
pop amplified technique, each organism
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2200569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
pop amplified technique, each organism
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2200569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
pop ana reflex titer and pattern
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
2200674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.16
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$17.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$11.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$12.28
|
| Rate for Payer: Humana Medicare Advantage |
$11.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.16
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.97
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$22.32
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.16
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$9.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.39
|
| Rate for Payer: Zelis Worker's Compensation |
$12.24
|
|
|
pop ana reflex titer and pattern
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
2200674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$17.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$12.24
|
|
|
pop anti-adalimumab
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
2200669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$44.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.29
|
|
|
pop anti-adalimumab
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
2200669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$44.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$38.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$42.43
|
| Rate for Payer: Humana Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$64.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$38.57
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.57
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$54.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$38.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$77.14
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$99.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$38.57
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$32.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.28
|
| Rate for Payer: Zelis Worker's Compensation |
$31.29
|
|
|
pop anti-ej ab
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
pop anti-ej ab
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
pop anti glial nuclear ab type 1
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2299516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
pop anti glial nuclear ab type 1
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2299516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
