|
pop testosterone prof REF
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
2200626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.59 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$92.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$92.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$67.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$166.40
|
| Rate for Payer: GEHA Medicare |
$51.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Humana ChoiceCare |
$56.41
|
| Rate for Payer: Humana Medicare Advantage |
$51.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.28
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.18
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.56
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.25
|
| Rate for Payer: United Healthcare Commercial |
$176.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.28
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Medicare |
$43.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.54
|
| Rate for Payer: Zelis Worker's Compensation |
$47.66
|
|
|
pop testosterone prof REF
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
2200626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.66 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$67.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.66
|
|
|
pop testo total hs female REF070001
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
2202647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$46.45
|
| 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 |
$46.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.81
|
| 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 |
$45.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$25.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$28.39
|
| Rate for Payer: Humana Medicare Advantage |
$25.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$43.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.81
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.88
|
| 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 |
$43.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$51.62
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.29
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.81
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$21.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.97
|
| Rate for Payer: Zelis Worker's Compensation |
$32.42
|
|
|
pop testo total hs female REF070001
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
2202647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.42 |
| 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 |
$45.85
|
| 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 |
$32.42
|
|
|
pop t helper ref
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2200512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.93 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$84.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$84.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$79.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: GEHA Medicare |
$46.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Humana ChoiceCare |
$51.68
|
| Rate for Payer: Humana Medicare Advantage |
$46.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$78.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$68.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$46.98
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.87
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$68.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$46.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$93.96
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.04
|
| Rate for Payer: United Healthcare Commercial |
$276.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$46.98
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Medicare |
$39.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.38
|
| Rate for Payer: Zelis Worker's Compensation |
$56.19
|
|
|
pop t helper ref
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2200512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$79.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$56.19
|
|
|
pop thyroglobulin
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2200043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$24.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: GEHA Medicare |
$16.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$17.67
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.06
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.12
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.74
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.06
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Medicare |
$13.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.27
|
| Rate for Payer: Zelis Worker's Compensation |
$17.63
|
|
|
pop thyroglobulin
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2200043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$24.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$17.63
|
|
|
pop tissue cult lymphocyte REF
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2200109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.02 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$209.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$209.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$166.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$116.49
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$568.80
|
| Rate for Payer: GEHA Medicare |
$116.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Humana ChoiceCare |
$128.14
|
| Rate for Payer: Humana Medicare Advantage |
$116.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$195.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$116.49
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$198.03
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$195.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$169.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$116.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$232.98
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$114.16
|
| Rate for Payer: United Healthcare Commercial |
$604.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$116.49
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Medicare |
$99.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.79
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
pop tissue cult lymphocyte REF
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2200109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$497.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
pop TISSUE CULTURE REF
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2200317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
pop TISSUE CULTURE REF
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2200317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.02 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$209.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$209.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$166.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$116.49
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$116.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Humana ChoiceCare |
$128.14
|
| Rate for Payer: Humana Medicare Advantage |
$116.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$195.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$116.49
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$198.03
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$195.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$169.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$116.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$232.98
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$114.16
|
| Rate for Payer: United Healthcare Commercial |
$841.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$116.49
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Medicare |
$99.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.79
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
pop total psa
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
2200677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$183.60
|
| Rate for Payer: First Health Commercial |
$194.40
|
| Rate for Payer: First Health Workers Compensation |
$27.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$194.40
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$194.40
|
| Rate for Payer: Multiplan All |
$196.56
|
| Rate for Payer: OMNI Networks Commercial |
$151.20
|
| Rate for Payer: One Health Plan PPO/POS |
$194.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$205.20
|
| Rate for Payer: Three Rivers Provider Network All |
$162.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$200.88
|
| Rate for Payer: Zelis Auto |
$86.40
|
| Rate for Payer: Zelis Worker's Compensation |
$19.77
|
|
|
pop total psa
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
2200677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$183.60
|
| Rate for Payer: First Health Commercial |
$194.40
|
| Rate for Payer: First Health Workers Compensation |
$27.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$194.40
|
| Rate for Payer: GEHA Commercial |
$172.80
|
| Rate for Payer: GEHA Medicare |
$18.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$194.40
|
| Rate for Payer: Humana ChoiceCare |
$20.23
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.39
|
| Rate for Payer: Multiplan All |
$196.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.26
|
| Rate for Payer: OMNI Networks Commercial |
$151.20
|
| Rate for Payer: One Health Plan PPO/POS |
$194.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.78
|
| Rate for Payer: Three Rivers Provider Network All |
$162.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.02
|
| Rate for Payer: United Healthcare Commercial |
$183.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$200.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.39
|
| Rate for Payer: Zelis Auto |
$86.40
|
| Rate for Payer: Zelis Medicare |
$15.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.07
|
| Rate for Payer: Zelis Worker's Compensation |
$19.77
|
|
|
pop total t4
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
2200703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$12.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$6.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$7.56
|
| Rate for Payer: Humana Medicare Advantage |
$6.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.87
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.68
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.74
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.73
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.87
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$5.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.24
|
| Rate for Payer: Zelis Worker's Compensation |
$8.69
|
|
|
pop total t4
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
2200703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$12.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.69
|
|
|
pop TRICHOMONAS VAG pcr REF
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
2200070
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$45.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$70.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$32.52
|
|
|
pop TRICHOMONAS VAG pcr REF
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
2200070
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$45.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$32.52
|
|
|
pop t suppressor ref
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
2200513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$61.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Worker's Compensation |
$43.74
|
|
|
pop t suppressor ref
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
2200513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$217.55 |
| 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 |
$137.40
|
| 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 |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$61.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: GEHA Medicare |
$37.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| 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 |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.14
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| 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 |
$217.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$75.46
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.98
|
| Rate for Payer: United Healthcare Commercial |
$194.65
|
| 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 |
$212.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.73
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Medicare |
$32.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.28
|
| Rate for Payer: Zelis Worker's Compensation |
$43.74
|
|
|
pop ua auto REF
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
2201002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$3.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.68
|
|
|
pop ua auto REF
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
2201002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$3.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: GEHA Medicare |
$2.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$2.48
|
| Rate for Payer: Humana Medicare Advantage |
$2.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.25
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.83
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.50
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.25
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Medicare |
$1.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.70
|
| Rate for Payer: Zelis Worker's Compensation |
$2.68
|
|
|
pop ureaplasma spp NAA
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
2200763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: First Health Workers Compensation |
$40.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
pop ureaplasma spp NAA
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
2200763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: First Health Workers Compensation |
$40.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$158.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
pop uric acid urn 306266
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2202038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.08
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: First Health Commercial |
$72.00
|
| Rate for Payer: First Health Workers Compensation |
$8.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.00
|
| Rate for Payer: GEHA Commercial |
$64.00
|
| Rate for Payer: GEHA Medicare |
$5.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.00
|
| Rate for Payer: Humana ChoiceCare |
$5.59
|
| Rate for Payer: Humana Medicare Advantage |
$5.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.08
|
| Rate for Payer: Multiplan All |
$72.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.64
|
| Rate for Payer: OMNI Networks Commercial |
$56.00
|
| Rate for Payer: One Health Plan PPO/POS |
$72.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.16
|
| Rate for Payer: Three Rivers Provider Network All |
$60.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$68.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.08
|
| Rate for Payer: Zelis Auto |
$32.00
|
| Rate for Payer: Zelis Medicare |
$4.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.10
|
| Rate for Payer: Zelis Worker's Compensation |
$6.05
|
|
