|
POP RI AB
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
pop saccharomyces cerevisiae IgA ab
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
22990335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$19.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$12.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.25
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.82
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.50
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.25
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$10.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.70
|
| Rate for Payer: Zelis Worker's Compensation |
$13.73
|
|
|
pop saccharomyces cerevisiae IgA ab
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
22990335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$19.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$13.73
|
|
|
pop saccharomyces cerevisiae IgG ab
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
22990334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$19.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$12.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.25
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.82
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.50
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.25
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$10.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.70
|
| Rate for Payer: Zelis Worker's Compensation |
$13.73
|
|
|
pop saccharomyces cerevisiae IgG ab
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
22990334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$19.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$13.73
|
|
|
pop sae1 ab
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
pop sae1 ab
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
pop salmonella and shigella ref
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
2299096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.75 |
| 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 |
$16.61
|
| 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 |
$11.75
|
|
|
pop salmonella and shigella ref
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
2299096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.00
|
| 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 |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.44
|
| 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 |
$16.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$150.40
|
| Rate for Payer: GEHA Medicare |
$9.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Humana ChoiceCare |
$10.38
|
| Rate for Payer: Humana Medicare Advantage |
$9.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.44
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.05
|
| 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 |
$15.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.88
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$159.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.44
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Medicare |
$8.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.33
|
| Rate for Payer: Zelis Worker's Compensation |
$11.75
|
|
|
pop SLIDE REVIEW MORPH / PLT FROM CBC
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
2239385
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.43
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$5.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: GEHA Medicare |
$3.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$3.77
|
| Rate for Payer: Humana Medicare Advantage |
$3.43
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.43
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.83
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6.86
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.36
|
| Rate for Payer: United Healthcare Commercial |
$43.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Medicare |
$2.92
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.12
|
| Rate for Payer: Zelis Worker's Compensation |
$3.75
|
|
|
pop SLIDE REVIEW MORPH / PLT FROM CBC
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
2239385
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$5.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.75
|
|
|
pop smear ova and parasite
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
22990890
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$15.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: GEHA Medicare |
$8.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$9.79
|
| Rate for Payer: Humana Medicare Advantage |
$8.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.90
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.13
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.80
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$119.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.90
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Medicare |
$7.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.26
|
|
|
pop smear ova and parasite
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
22990890
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$15.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.26
|
|
|
pop sodium urn 306266
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2202036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
pop sodium urn 306266
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2202036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$5.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$5.57
|
| Rate for Payer: Humana Medicare Advantage |
$5.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.06
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.60
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.12
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.96
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.06
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$4.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.07
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
pop solvent inhalants profile urine
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 82441
|
| Hospital Charge Code |
2200706
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
pop solvent inhalants profile urine
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 82441
|
| Hospital Charge Code |
2200706
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: GEHA Medicare |
$6.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$6.61
|
| Rate for Payer: Humana Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.01
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.22
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.02
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.89
|
| Rate for Payer: United Healthcare Commercial |
$15.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.01
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Medicare |
$5.11
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.21
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
pop substitution plasma frac ea REF
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop substitution plasma frac ea REF
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
2200342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
pop sulfate urn 306266
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
2202037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$7.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.54
|
|
|
pop sulfate urn 306266
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
2202037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.49
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$7.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$6.04
|
| Rate for Payer: Humana Medicare Advantage |
$5.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.49
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.33
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.98
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.38
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.49
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.59
|
| Rate for Payer: Zelis Worker's Compensation |
$5.54
|
|
|
pop t-and b- lymph diff profile
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
2200609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$57.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$40.67
|
|
|
pop t-and b- lymph diff profile
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
2200609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$236.55 |
| 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 |
$149.40
|
| 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 |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$57.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$37.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| 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 |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.14
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$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 |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$75.46
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.98
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| 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 |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.73
|
| Rate for Payer: Zelis Auto |
$99.60
|
| 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
|
|
|
pop testo shbg ref
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2299500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$33.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$23.44
|
|
|
pop testo shbg ref
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2299500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.73
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$33.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$21.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$23.90
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$36.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.73
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.94
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$36.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$43.46
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.30
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.73
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$18.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.08
|
| Rate for Payer: Zelis Worker's Compensation |
$23.44
|
|
