|
pop antiphospholipid syndrome 2
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
2200659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$10.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: GEHA Medicare |
$5.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$6.35
|
| Rate for Payer: Humana Medicare Advantage |
$5.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.77
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.81
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.54
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.65
|
| Rate for Payer: United Healthcare Commercial |
$89.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.77
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Medicare |
$4.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.92
|
| Rate for Payer: Zelis Worker's Compensation |
$7.43
|
|
|
pop anti-pl-12 ab
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200834
|
|
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-pl-12 ab
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200834
|
|
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-pl-7 ab
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200833
|
|
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-pl-7 ab
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200833
|
|
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-pm/sci-100
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$130.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-pm/sci-100
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$148.58
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$157.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-pr3 163068
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200798
|
|
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-pr3 163068
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200798
|
|
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 antiproteinase (PR-3) abs
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| 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 |
$20.24
|
| 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 |
$14.31
|
|
|
pop antiproteinase (PR-3) abs
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| 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 |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| 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 |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| 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 |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
Pop anti ribosomal p
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200856
|
|
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 ribosomal p
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200856
|
|
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-srp ab
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200831
|
|
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-srp ab
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200831
|
|
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-ss-a 52kd ab
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$130.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-ss-a 52kd ab
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$148.58
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$157.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-tif-1 gamma
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$130.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-tif-1 gamma
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$148.58
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$157.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-u1 rnp
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$148.58
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$157.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-u1 rnp
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$130.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-u2 rnp ab
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$148.58
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$157.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop anti-u2 rnp ab
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cash Price |
$111.44
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: First Health Commercial |
$167.16
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.16
|
| Rate for Payer: GEHA Commercial |
$130.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.16
|
| Rate for Payer: Multiplan All |
$169.01
|
| Rate for Payer: OMNI Networks Commercial |
$130.01
|
| Rate for Payer: One Health Plan PPO/POS |
$167.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.44
|
| Rate for Payer: Three Rivers Provider Network All |
$139.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.73
|
| Rate for Payer: Zelis Auto |
$74.29
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
pop atopobium vaginae ref
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2299548
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$318.25 |
| 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 |
$201.00
|
| 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 |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| 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 |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| 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 |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$284.75
|
| 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 |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$134.00
|
| 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 atopobium vaginae ref
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2299548
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
