|
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
|
|
|
pop growth hormone 6
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200553
|
|
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 6
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200553
|
|
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 7
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200554
|
|
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 7
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200554
|
|
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 8
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200555
|
|
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 8
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200555
|
|
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 9
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200556
|
|
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 9
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2200556
|
|
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 gtt added samples ref
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
2299541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.92
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: GEHA Medicare |
$3.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$4.31
|
| Rate for Payer: Humana Medicare Advantage |
$3.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.92
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.66
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.84
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.84
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.92
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Medicare |
$3.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.70
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
pop gtt added samples ref
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
2299541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
pop HERPES SIMPLEX VIRUS 1 IGM REF
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
2299273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$20.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.80
|
|
|
pop HERPES SIMPLEX VIRUS 1 IGM REF
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
2299273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$108.30 |
| 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 |
$68.40
|
| 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 |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$20.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: GEHA Medicare |
$13.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| 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 |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.42
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| 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 |
$108.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.38
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| 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 |
$106.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.19
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Medicare |
$11.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.83
|
| Rate for Payer: Zelis Worker's Compensation |
$14.80
|
|
|
pop HERPES SIMPLEX VIRUS 2 IGG REF
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2299272
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$19.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$21.29
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.35
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.90
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38.70
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.35
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$16.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.22
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
pop HERPES SIMPLEX VIRUS 2 IGG REF
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2299272
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
pop HERPES SIMPLEX VIRUS 2 IGM REF
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2299274
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$19.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$21.29
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.35
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.90
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38.70
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.35
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$16.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.22
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
pop HERPES SIMPLEX VIRUS 2 IGM REF
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2299274
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
pop hge IgG titer
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2200697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$111.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Worker's Compensation |
$13.58
|
|
|
pop hge IgG titer
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2200697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$151.05 |
| 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 |
$95.40
|
| 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 |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$127.20
|
| Rate for Payer: GEHA Medicare |
$10.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| 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 |
$144.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.31
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| 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 |
$151.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.36
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$135.15
|
| 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 |
$147.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.18
|
| Rate for Payer: Zelis Auto |
$63.60
|
| 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 hge IgM
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2200698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$151.05 |
| 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 |
$95.40
|
| 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 |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$127.20
|
| Rate for Payer: GEHA Medicare |
$10.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| 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 |
$144.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.31
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| 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 |
$151.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.36
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$135.15
|
| 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 |
$147.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.18
|
| Rate for Payer: Zelis Auto |
$63.60
|
| 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 hge IgM
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2200698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$19.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$111.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Worker's Compensation |
$13.58
|
|
|
pop HIGH SENS TESTO FREE REF
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
2299078
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: First Health Workers Compensation |
$46.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Worker's Compensation |
$33.17
|
|
|
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|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
2299078
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: First Health Workers Compensation |
$46.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: GEHA Medicare |
$25.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$28.02
|
| Rate for Payer: Humana Medicare Advantage |
$25.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.47
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.30
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.94
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.96
|
| Rate for Payer: United Healthcare Commercial |
$189.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.47
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Medicare |
$21.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.56
|
| Rate for Payer: Zelis Worker's Compensation |
$33.17
|
|
|
pop histoplasma mycelial cf ab
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
2200535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$86.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
|
pop histoplasma mycelial cf ab
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
2200535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.79
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$98.40
|
| Rate for Payer: GEHA Medicare |
$13.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Humana ChoiceCare |
$15.17
|
| Rate for Payer: Humana Medicare Advantage |
$13.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.79
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.44
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.58
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.51
|
| Rate for Payer: United Healthcare Commercial |
$104.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.79
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Medicare |
$11.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.55
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
