|
PROSTATECTOMY (TURP)
|
Facility
|
IP
|
$1,744.00
|
|
|
Service Code
|
CPT 52601
|
| Hospital Charge Code |
6152601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.11 |
| Max. Negotiated Rate |
$1,656.80 |
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$1,482.40
|
| Rate for Payer: First Health Commercial |
$1,569.60
|
| Rate for Payer: First Health Workers Compensation |
$673.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,569.60
|
| Rate for Payer: GEHA Commercial |
$1,220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,569.60
|
| Rate for Payer: Multiplan All |
$1,587.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,220.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,569.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,656.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,308.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,621.92
|
| Rate for Payer: Zelis Auto |
$697.60
|
| Rate for Payer: Zelis Worker's Compensation |
$476.11
|
|
|
PROSTATE LASER ENUCLEATION
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 52649
|
| Hospital Charge Code |
6152649
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.46 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,016.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cigna Commercial |
$1,439.90
|
| Rate for Payer: First Health Commercial |
$1,524.60
|
| Rate for Payer: First Health Workers Compensation |
$654.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,524.60
|
| Rate for Payer: GEHA Commercial |
$1,355.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,524.60
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,541.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,524.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,609.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,270.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,575.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$677.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$462.46
|
|
|
PROSTATE LASER ENUCLEATION
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 52649
|
| Hospital Charge Code |
6152649
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.46 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cigna Commercial |
$1,439.90
|
| Rate for Payer: First Health Commercial |
$1,524.60
|
| Rate for Payer: First Health Workers Compensation |
$654.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,524.60
|
| Rate for Payer: GEHA Commercial |
$1,185.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,524.60
|
| Rate for Payer: Multiplan All |
$1,541.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,524.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,609.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,575.42
|
| Rate for Payer: Zelis Auto |
$677.60
|
| Rate for Payer: Zelis Worker's Compensation |
$462.46
|
|
|
PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
8900018
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,256.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,256.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$995.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: First Health Workers Compensation |
$289.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$600.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,016.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,173.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,016.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,016.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$205.02
|
|
|
PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
6155700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,256.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,256.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$995.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$329.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,016.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,173.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,016.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,016.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$112.48
|
|
|
PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
8900018
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: First Health Workers Compensation |
$289.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$525.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Worker's Compensation |
$205.02
|
|
|
PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
6155700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$288.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Worker's Compensation |
$112.48
|
|
|
PROSTATE SATURATION SAMPLING
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 55706
|
| Hospital Charge Code |
6155706
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$910.10 |
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$670.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: Zelis Auto |
$383.20
|
| Rate for Payer: Zelis Worker's Compensation |
$261.53
|
|
|
PROSTATE SATURATION SAMPLING
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 55706
|
| Hospital Charge Code |
6155706
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,256.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,256.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$995.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$766.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,016.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,173.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,016.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,016.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$383.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$261.53
|
|
|
PROSTATIC RF THERMOTX
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 53852
|
| Hospital Charge Code |
6153852
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.96 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$703.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cigna Commercial |
$996.20
|
| Rate for Payer: First Health Commercial |
$1,054.80
|
| Rate for Payer: First Health Workers Compensation |
$452.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,054.80
|
| Rate for Payer: GEHA Commercial |
$937.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,054.80
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,066.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$820.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,054.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,113.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$879.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$468.80
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$319.96
|
|
|
PROSTATIC RF THERMOTX
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 53852
|
| Hospital Charge Code |
6153852
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.96 |
| Max. Negotiated Rate |
$1,113.40 |
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cigna Commercial |
$996.20
|
| Rate for Payer: First Health Commercial |
$1,054.80
|
| Rate for Payer: First Health Workers Compensation |
$452.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,054.80
|
| Rate for Payer: GEHA Commercial |
$820.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,054.80
|
| Rate for Payer: Multiplan All |
$1,066.52
|
| Rate for Payer: OMNI Networks Commercial |
$820.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,054.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,113.40
|
| Rate for Payer: Three Rivers Provider Network All |
$879.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.96
|
| Rate for Payer: Zelis Auto |
$468.80
|
| Rate for Payer: Zelis Worker's Compensation |
$319.96
|
|
|
PROTAMINE SULFATE 50MG/5ML
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J2720
|
| Hospital Charge Code |
3301130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
PROTAMINE SULFATE 50MG/5ML
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J2720
|
| Hospital Charge Code |
3301130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$1.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
prot/crea urine randomREF003129
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2200729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$9.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$143.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.50
|
|
|
prot/crea urine randomREF003129
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2200729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$9.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$164.00
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$174.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$6.50
|
|
|
PROTEINASE 3 AB PR3 REF
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
2300052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$31.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.13
|
|
|
PROTEINASE 3 AB PR3 REF
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
2300052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$31.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: GEHA Medicare |
$15.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$16.55
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.05
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.59
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.10
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.75
|
| Rate for Payer: United Healthcare Commercial |
$203.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.05
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Medicare |
$12.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.06
|
| Rate for Payer: Zelis Worker's Compensation |
$22.13
|
|
|
protein c antigen REF080465
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
2299181
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.01
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$22.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$12.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$13.21
|
| Rate for Payer: Humana Medicare Advantage |
$12.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.01
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.42
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.02
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$347.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.01
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$10.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.41
|
| Rate for Payer: Zelis Worker's Compensation |
$15.77
|
|
|
protein c antigen REF080465
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
2299181
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$22.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.77
|
|
|
protein c functional REF117705
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
2299182
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.84
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$24.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: GEHA Medicare |
$13.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Humana ChoiceCare |
$15.22
|
| Rate for Payer: Humana Medicare Advantage |
$13.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.84
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.53
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.68
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.56
|
| Rate for Payer: United Healthcare Commercial |
$297.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.84
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Medicare |
$11.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.61
|
| Rate for Payer: Zelis Worker's Compensation |
$17.22
|
|
|
protein c functional REF117705
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
2299182
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$24.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.22
|
|
|
protein electrophoresis serum REF225920
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
2990372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$19.34
|
| 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 |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.74
|
| 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 |
$34.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$10.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$11.81
|
| Rate for Payer: Humana Medicare Advantage |
$10.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.74
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.26
|
| 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 |
$18.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.48
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.74
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$9.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.89
|
| Rate for Payer: Zelis Worker's Compensation |
$24.09
|
|
|
protein electrophoresis serum REF225920
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
2990372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| 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 |
$34.08
|
| 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 |
$24.09
|
|
|
protein s activity REF164525
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2200201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$27.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.15
|
|
|
protein s activity REF164525
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2200201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$27.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$15.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.32
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.04
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.64
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.01
|
| Rate for Payer: United Healthcare Commercial |
$224.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.32
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$13.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.38
|
| Rate for Payer: Zelis Worker's Compensation |
$19.15
|
|
