|
pop INFLUENZA A
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
21600801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$54.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
pop INFLUENZA B
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
21600802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$54.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
pop INFLUENZA B
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2203539
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$54.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
pop INFLUENZA B
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2203539
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$62.40
|
| Rate for Payer: GEHA Medicare |
$16.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.55
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.14
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$66.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.55
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Medicare |
$14.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.86
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
pop INFLUENZA B
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
21600802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$62.40
|
| Rate for Payer: GEHA Medicare |
$16.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.55
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.14
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$66.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.55
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Medicare |
$14.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.86
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
POP KAPPA LG CHAIN (Vitros)
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2232281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$14.96
|
| Rate for Payer: Humana Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.60
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.12
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.20
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.60
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$11.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.32
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
POP KAPPA LG CHAIN (Vitros)
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2232281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
pop KAPPA LIGHT CHAIN T/R/U/S (LAB)
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2299286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$14.96
|
| Rate for Payer: Humana Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.60
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.12
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.20
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.60
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$11.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.32
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
pop KAPPA LIGHT CHAIN T/R/U/S (LAB)
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2299286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
pop LAMBDA LIGHT CHAIN,T/R/U/S (LAB)
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2299287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
pop LAMBDA LIGHT CHAIN,T/R/U/S (LAB)
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2299287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$14.96
|
| Rate for Payer: Humana Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.60
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.12
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.20
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.60
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$11.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.32
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
POP LAMBDA LT CHAIN (Vitros)
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2232282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$14.96
|
| Rate for Payer: Humana Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.60
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.12
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.20
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.60
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$11.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.32
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
POP LAMBDA LT CHAIN (Vitros)
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2232282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
pop LD isoenzymes
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2200593
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.79
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$21.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$12.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$14.07
|
| Rate for Payer: Humana Medicare Advantage |
$12.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.79
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.74
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.58
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.53
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.79
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$10.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.35
|
| Rate for Payer: Zelis Worker's Compensation |
$15.08
|
|
|
pop LD isoenzymes
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2200593
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$21.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.08
|
|
|
pop lipoprotein blood quant
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
2200506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.01 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$58.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$131.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Worker's Compensation |
$41.01
|
|
|
pop lipoprotein blood quant
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
2200506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$34.19
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$58.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$150.40
|
| Rate for Payer: GEHA Medicare |
$34.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Humana ChoiceCare |
$37.61
|
| Rate for Payer: Humana Medicare Advantage |
$34.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$57.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$49.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$34.19
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.12
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$49.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$34.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$68.38
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.51
|
| Rate for Payer: United Healthcare Commercial |
$159.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$34.19
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Medicare |
$29.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.03
|
| Rate for Payer: Zelis Worker's Compensation |
$41.01
|
|
|
POP LYME DIS IgG CSF
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2200532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$25.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$119.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.06
|
|
|
POP LYME DIS IgG CSF
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2200532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$25.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$136.80
|
| Rate for Payer: GEHA Medicare |
$15.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Humana ChoiceCare |
$17.04
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.49
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.33
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.98
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.49
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Medicare |
$13.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.59
|
| Rate for Payer: Zelis Worker's Compensation |
$18.06
|
|
|
POP LYME DIS IgM CSF
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2200533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$25.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$136.80
|
| Rate for Payer: GEHA Medicare |
$15.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Humana ChoiceCare |
$17.04
|
| Rate for Payer: Humana Medicare Advantage |
$15.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.49
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.33
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.98
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.49
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Medicare |
$13.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.59
|
| Rate for Payer: Zelis Worker's Compensation |
$18.06
|
|
|
POP LYME DIS IgM CSF
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
2200533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$25.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$119.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.06
|
|
|
pop lymphocyte activity panel 1
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
2200663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$46.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$26.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$29.46
|
| Rate for Payer: Humana Medicare Advantage |
$26.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$44.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$38.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$26.78
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.53
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$38.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$26.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$53.56
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.24
|
| Rate for Payer: United Healthcare Commercial |
$181.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$26.78
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$22.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.14
|
| Rate for Payer: Zelis Worker's Compensation |
$33.15
|
|
|
pop lymphocyte activity panel 1
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
2200663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$46.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$33.15
|
|
|
pop lymphocyte activity panel 2
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
2200664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$57.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.67
|
|
|
pop lymphocyte activity panel 2
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
2200664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$53.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$57.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$37.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$41.50
|
| Rate for Payer: Humana Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$63.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$54.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$37.73
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.14
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$63.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$54.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$37.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$75.46
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.98
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.73
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$32.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.28
|
| Rate for Payer: Zelis Worker's Compensation |
$40.67
|
|
