|
REPAIR WRIST JOINTS
|
Facility
|
IP
|
$1,686.00
|
|
|
Service Code
|
CPT 25447
|
| Hospital Charge Code |
6125447
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.28 |
| Max. Negotiated Rate |
$1,601.70 |
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$1,433.10
|
| Rate for Payer: First Health Commercial |
$1,517.40
|
| Rate for Payer: First Health Workers Compensation |
$650.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,517.40
|
| Rate for Payer: GEHA Commercial |
$1,180.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,517.40
|
| Rate for Payer: Multiplan All |
$1,534.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,180.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,517.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,601.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,264.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.98
|
| Rate for Payer: Zelis Auto |
$674.40
|
| Rate for Payer: Zelis Worker's Compensation |
$460.28
|
|
|
REPEAT CO2 VENOUS
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
2200147
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$51.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
REPEAT CO2 VENOUS
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
2300108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$51.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
REPEAT CO2 VENOUS
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
2200147
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$58.40
|
| Rate for Payer: GEHA Medicare |
$4.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Humana ChoiceCare |
$5.37
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.88
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.30
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.76
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.78
|
| Rate for Payer: United Healthcare Commercial |
$62.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.88
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Medicare |
$4.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.86
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
REPEAT CO2 VENOUS
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
2300108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$58.40
|
| Rate for Payer: GEHA Medicare |
$4.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Humana ChoiceCare |
$5.37
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.88
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.30
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.76
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.78
|
| Rate for Payer: United Healthcare Commercial |
$62.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.88
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Medicare |
$4.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.86
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
6130906
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna Commercial |
$363.80
|
| Rate for Payer: First Health Commercial |
$385.20
|
| Rate for Payer: First Health Workers Compensation |
$165.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$385.20
|
| Rate for Payer: GEHA Commercial |
$342.40
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$385.20
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$389.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$299.60
|
| Rate for Payer: One Health Plan PPO/POS |
$385.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$406.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$321.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$171.20
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$116.84
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
6130906
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$406.60 |
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna Commercial |
$363.80
|
| Rate for Payer: First Health Commercial |
$385.20
|
| Rate for Payer: First Health Workers Compensation |
$165.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$385.20
|
| Rate for Payer: GEHA Commercial |
$299.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$385.20
|
| Rate for Payer: Multiplan All |
$389.48
|
| Rate for Payer: OMNI Networks Commercial |
$299.60
|
| Rate for Payer: One Health Plan PPO/POS |
$385.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$406.60
|
| Rate for Payer: Three Rivers Provider Network All |
$321.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.04
|
| Rate for Payer: Zelis Auto |
$171.20
|
| Rate for Payer: Zelis Worker's Compensation |
$116.84
|
|
|
REPEAT CONTROL OF NOSEBLEEDL
|
Facility
|
OP
|
$1,101.00
|
|
| Hospital Charge Code |
8130906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$935.85
|
| Rate for Payer: First Health Commercial |
$990.90
|
| Rate for Payer: First Health Workers Compensation |
$425.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.90
|
| Rate for Payer: GEHA Commercial |
$880.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.90
|
| Rate for Payer: Humana ChoiceCare |
$286.26
|
| Rate for Payer: Multiplan All |
$1,001.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$660.60
|
| Rate for Payer: OMNI Networks Commercial |
$770.70
|
| Rate for Payer: One Health Plan PPO/POS |
$990.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.95
|
| Rate for Payer: Three Rivers Provider Network All |
$825.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$968.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.93
|
| Rate for Payer: Zelis Auto |
$440.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$550.50
|
| Rate for Payer: Zelis Worker's Compensation |
$300.57
|
|
|
REPEAT CONTROL OF NOSEBLEEDL
|
Facility
|
IP
|
$1,101.00
|
|
| Hospital Charge Code |
8130906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.57 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$935.85
|
| Rate for Payer: First Health Commercial |
$990.90
|
| Rate for Payer: First Health Workers Compensation |
$425.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.90
|
| Rate for Payer: GEHA Commercial |
$770.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.90
|
| Rate for Payer: Multiplan All |
$1,001.91
|
| Rate for Payer: OMNI Networks Commercial |
$770.70
|
| Rate for Payer: One Health Plan PPO/POS |
$990.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.95
|
| Rate for Payer: Three Rivers Provider Network All |
$825.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.93
|
| Rate for Payer: Zelis Auto |
$440.40
|
| Rate for Payer: Zelis Worker's Compensation |
$300.57
|
|
|
REPEAT GLUCOSE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2299904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
REPEAT GLUCOSE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2299904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$4.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.93
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
REPEAT HEMATOCRIT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
22990767
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
REPEAT HEMATOCRIT
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2299909
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$36.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
REPEAT HEMATOCRIT
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2299909
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$41.60
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$44.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
REPEAT HEMATOCRIT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
22990767
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
REPEAT HEMOGLOBIN
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2299908
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$4.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$36.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2.93
|
|
|
REPEAT HEMOGLOBIN
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2299908
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$4.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$41.60
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$44.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.93
|
|
|
REPEAT LIVER PROFILE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
2299903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: First Health Commercial |
$270.00
|
| Rate for Payer: First Health Workers Compensation |
$14.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.00
|
| Rate for Payer: GEHA Commercial |
$240.00
|
| Rate for Payer: GEHA Medicare |
$8.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.00
|
| Rate for Payer: Humana ChoiceCare |
$8.99
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.17
|
| Rate for Payer: Multiplan All |
$273.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.89
|
| Rate for Payer: OMNI Networks Commercial |
$210.00
|
| Rate for Payer: One Health Plan PPO/POS |
$270.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.34
|
| Rate for Payer: Three Rivers Provider Network All |
$225.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.01
|
| Rate for Payer: United Healthcare Commercial |
$255.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.17
|
| Rate for Payer: Zelis Auto |
$120.00
|
| Rate for Payer: Zelis Medicare |
$6.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.80
|
| Rate for Payer: Zelis Worker's Compensation |
$9.93
|
|
|
REPEAT LIVER PROFILE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
2299903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: First Health Commercial |
$270.00
|
| Rate for Payer: First Health Workers Compensation |
$14.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.00
|
| Rate for Payer: GEHA Commercial |
$210.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.00
|
| Rate for Payer: Multiplan All |
$273.00
|
| Rate for Payer: OMNI Networks Commercial |
$210.00
|
| Rate for Payer: One Health Plan PPO/POS |
$270.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$225.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.00
|
| Rate for Payer: Zelis Auto |
$120.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.93
|
|
|
REPEAT MAGNESIUM SERUM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2299907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$12.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.37
|
| Rate for Payer: Humana Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.70
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.39
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.40
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.57
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.70
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.04
|
| Rate for Payer: Zelis Worker's Compensation |
$8.53
|
|
|
REPEAT MAGNESIUM SERUM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2299907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$12.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.53
|
|
|
REPEAT PHOSPHORUS SERUM
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
2204101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
REPEAT PHOSPHORUS SERUM
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
2204101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: GEHA Medicare |
$4.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$5.21
|
| Rate for Payer: Humana Medicare Advantage |
$4.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.74
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.06
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.48
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$90.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.74
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Medicare |
$4.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.69
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
REPEAT POTASSIUM
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
2299900
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$42.40
|
| Rate for Payer: GEHA Medicare |
$4.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Humana ChoiceCare |
$5.24
|
| Rate for Payer: Humana Medicare Advantage |
$4.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.76
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.09
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.52
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.66
|
| Rate for Payer: United Healthcare Commercial |
$45.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.76
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Medicare |
$4.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.71
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
REPEAT POTASSIUM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
2299900
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$37.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
