|
pop atypical panca
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
2200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
pop atypical panca
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
2200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$227.05 |
| 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 |
$143.40
|
| 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 |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| 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 |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| 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 |
$227.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$203.15
|
| 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 |
$222.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$95.60
|
| 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 atypical p-anca 162402
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86037
|
| Hospital Charge Code |
2200801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| 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 |
$14.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$9.67
|
|
|
pop atypical p-anca 162402
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86037
|
| Hospital Charge Code |
2200801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.67
|
|
|
pop Bartonella henselae Antibodie IgG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2299246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$10.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$11.20
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.18
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.31
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.36
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.18
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$8.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.22
|
| Rate for Payer: Zelis Worker's Compensation |
$13.58
|
|
|
pop Bartonella henselae Antibodie IgG
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2299246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$13.58
|
|
|
pop Bartonella henselae Antibodie IgM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2299247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$13.58
|
|
|
pop Bartonella henselae Antibodie IgM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2299247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$10.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$11.20
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.18
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.31
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.36
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.18
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$8.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.22
|
| Rate for Payer: Zelis Worker's Compensation |
$13.58
|
|
|
pop base cortisol REF004051
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200851
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.30
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$16.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.30
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.71
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.97
|
| Rate for Payer: United Healthcare Commercial |
$227.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.30
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$13.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.56
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
pop base cortisol REF004051
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200851
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
pop Bordete pertus DNA, Qual, R/T PCR
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2299321
|
|
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 Bordete pertus DNA, Qual, R/T PCR
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2299321
|
|
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
|
|
|
pop b pertussis abs, IgA REF164384
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2299227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$21.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
pop b pertussis abs, IgA REF164384
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2299227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$21.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$13.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$14.51
|
| Rate for Payer: Humana Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.19
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.42
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.38
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.19
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$11.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.83
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
pop b pertussis abs, IgG REF161745
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2299226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$21.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$13.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$14.51
|
| Rate for Payer: Humana Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.19
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.42
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.38
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.19
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$11.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.83
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
pop b pertussis abs, IgG REF161745
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2299226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$21.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
pop b pertussis abs, IgM REF161752
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$21.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$13.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$14.51
|
| Rate for Payer: Humana Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.19
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.42
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.38
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.19
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$11.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.83
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
pop b pertussis abs, IgM REF161752
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$21.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
pop bvab 2 ref
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2299550
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$96.90 |
| 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 |
$61.20
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| 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 |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| 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 |
$96.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$86.70
|
| 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 |
$94.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$40.80
|
| 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 bvab 2 ref
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2299550
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
pop calcium channel ab n type
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299524
|
|
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 calcium channel ab n type
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299524
|
|
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 calcium channel ab pq type
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299523
|
|
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 calcium channel ab pq type
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299523
|
|
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 calcium ua 306266
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
2202025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$10.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.72
|
|
