|
BF LDH (Vitros)
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
2232288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
BF LDH (Vitros)
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
2232288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$6.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.64
|
| Rate for Payer: Humana Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.04
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.27
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.08
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.92
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.04
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$5.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.25
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
BF OTHER with DIFF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF OTHER with DIFF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PERICARDIAL with DIFF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PERICARDIAL with DIFF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PERITONEAL with DIFF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PERITONEAL with DIFF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PLEURAL with DIFF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PLEURAL with DIFF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF PROTEIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
2204175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.57 |
| 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 |
$7.87
|
| 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 |
$5.57
|
|
|
BF PROTEIN
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
2204175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.20
|
| 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 |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.00
|
| 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 |
$7.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: GEHA Medicare |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$4.40
|
| Rate for Payer: Humana Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.00
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.80
|
| 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 |
$6.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.00
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.00
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Medicare |
$3.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.57
|
|
|
BF PROTEIN (Vitros)
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
2232287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.57 |
| 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 |
$7.87
|
| 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 |
$5.57
|
|
|
BF PROTEIN (Vitros)
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
2232287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.20
|
| 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 |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.00
|
| 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 |
$7.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: GEHA Medicare |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$4.40
|
| Rate for Payer: Humana Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.00
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.80
|
| 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 |
$6.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.00
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.00
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Medicare |
$3.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.57
|
|
|
BF SYNOVIAL with DIFF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF SYNOVIAL with DIFF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BHV ID SUPPORT ASSMT BY 1 TECH EA 15 MIN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 97152
|
| Hospital Charge Code |
4397921
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
BHV ID SUPPORT ASSMT BY 1 TECH EA 15 MIN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 97152
|
| Hospital Charge Code |
4397921
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$21.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.94
|
|
|
BICALUTAMIDE 50 MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
3303153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
BICALUTAMIDE 50 MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 47335048583
|
| Hospital Charge Code |
3303153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
bile acids, frac and total REF503640
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
bile acids, frac and total REF503640
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$24.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.09
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.18
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.09
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$20.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.91
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
BILE ACIDS FRACTIONATED AND TOTAL PREGNA
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2300072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$24.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.09
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.18
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.09
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$20.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.91
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
BILE ACIDS FRACTIONATED AND TOTAL PREGNA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2300072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
BILE DUCT ENDOSCOPY ADD-ON
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 47550
|
| Hospital Charge Code |
6147550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$423.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Humana ChoiceCare |
$137.54
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$317.40
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$465.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.50
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
