|
pop emtitr+ glia abs 5
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
pop emtitr+ glia abs 5
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$182.40 |
| 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 |
$115.20
|
| 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 |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| 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 |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$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 |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| 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 |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$76.80
|
| 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 factor viii inhib prof 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop factor viii inhib prof 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop factor viii inhib prof 2
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop factor viii inhib prof 2
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop factor viii inhib prof 3
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop factor viii inhib prof 3
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200633
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop fdp
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
2200644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$12.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: GEHA Medicare |
$6.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$7.58
|
| Rate for Payer: Humana Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.89
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.71
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.78
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.75
|
| Rate for Payer: United Healthcare Commercial |
$187.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.89
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Medicare |
$5.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.27
|
| Rate for Payer: Zelis Worker's Compensation |
$9.11
|
|
|
pop fdp
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
2200644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$12.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.11
|
|
|
pop free psa
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2200678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$27.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$18.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$20.23
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.39
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.26
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.78
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.02
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.39
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$15.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.07
|
| Rate for Payer: Zelis Worker's Compensation |
$19.77
|
|
|
pop free psa
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2200678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$27.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$19.77
|
|
|
pop Gardner vag dna
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 87512
|
| Hospital Charge Code |
2200757
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$98.60
|
| Rate for Payer: First Health Commercial |
$104.40
|
| Rate for Payer: First Health Workers Compensation |
$67.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$104.40
|
| Rate for Payer: GEHA Commercial |
$81.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$104.40
|
| Rate for Payer: Multiplan All |
$105.56
|
| Rate for Payer: OMNI Networks Commercial |
$81.20
|
| Rate for Payer: One Health Plan PPO/POS |
$104.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$110.20
|
| Rate for Payer: Three Rivers Provider Network All |
$87.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$107.88
|
| Rate for Payer: Zelis Auto |
$46.40
|
| Rate for Payer: Zelis Worker's Compensation |
$47.99
|
|
|
pop Gardner vag dna
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 87512
|
| Hospital Charge Code |
2200757
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$75.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$69.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$75.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$59.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$41.76
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$98.60
|
| Rate for Payer: First Health Commercial |
$104.40
|
| Rate for Payer: First Health Workers Compensation |
$67.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$104.40
|
| Rate for Payer: GEHA Commercial |
$92.80
|
| Rate for Payer: GEHA Medicare |
$41.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$104.40
|
| Rate for Payer: Humana ChoiceCare |
$45.94
|
| Rate for Payer: Humana Medicare Advantage |
$41.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$70.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$60.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$41.76
|
| Rate for Payer: Multiplan All |
$105.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.99
|
| Rate for Payer: OMNI Networks Commercial |
$81.20
|
| Rate for Payer: One Health Plan PPO/POS |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$70.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$60.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$41.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$110.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$83.52
|
| Rate for Payer: Three Rivers Provider Network All |
$87.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.92
|
| Rate for Payer: United Healthcare Commercial |
$98.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$107.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$41.76
|
| Rate for Payer: Zelis Auto |
$46.40
|
| Rate for Payer: Zelis Medicare |
$35.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.11
|
| Rate for Payer: Zelis Worker's Compensation |
$47.99
|
|
|
pop growth hormone 1
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 1
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 10
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 10
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 2
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 2
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 3
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 3
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 4
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 4
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
pop growth hormone 5
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200552
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
