|
STRAPPING UNNA BOOT
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
9629580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$539.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
STRAPPING UNNA BOOT
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
21600155
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
STRAPPING UNNA BOOT
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
20300040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
STRAPPING UNNA BOOT
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
1900040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$519.20
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
|
STRAPPING UNNA BOOT
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
8729580
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
STRAPPING UNNA BOOT
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
9629580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$616.00
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
STRAVIX 2 X 2 SQCM
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7003078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$903.63 |
| Max. Negotiated Rate |
$3,144.50 |
| Rate for Payer: Cash Price |
$1,986.00
|
| Rate for Payer: Cigna Commercial |
$2,813.50
|
| Rate for Payer: First Health Commercial |
$2,979.00
|
| Rate for Payer: First Health Workers Compensation |
$1,277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,979.00
|
| Rate for Payer: GEHA Commercial |
$2,317.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,979.00
|
| Rate for Payer: Multiplan All |
$3,012.10
|
| Rate for Payer: OMNI Networks Commercial |
$2,317.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,979.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,144.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,482.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,078.30
|
| Rate for Payer: Zelis Auto |
$1,324.00
|
| Rate for Payer: Zelis Worker's Compensation |
$903.63
|
|
|
STRAVIX 2 X 2 SQCM
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7003078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$3,144.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,986.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$175.46
|
| Rate for Payer: Cash Price |
$1,986.00
|
| Rate for Payer: Cash Price |
$1,986.00
|
| Rate for Payer: Cigna Commercial |
$2,813.50
|
| Rate for Payer: First Health Commercial |
$2,979.00
|
| Rate for Payer: First Health Workers Compensation |
$1,277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,979.00
|
| Rate for Payer: GEHA Commercial |
$152.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,979.00
|
| Rate for Payer: Humana ChoiceCare |
$860.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$179.04
|
| Rate for Payer: Multiplan All |
$3,012.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,986.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,317.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,979.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$206.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$179.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,144.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,482.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,912.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,078.30
|
| Rate for Payer: Zelis Auto |
$1,324.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,655.00
|
| Rate for Payer: Zelis Worker's Compensation |
$903.63
|
|
|
STRAVIX 3X6CM
|
Facility
|
IP
|
$8,901.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7002932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,429.97 |
| Max. Negotiated Rate |
$8,455.95 |
| Rate for Payer: Cash Price |
$5,340.60
|
| Rate for Payer: Cigna Commercial |
$7,565.85
|
| Rate for Payer: First Health Commercial |
$8,010.90
|
| Rate for Payer: First Health Workers Compensation |
$3,436.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,010.90
|
| Rate for Payer: GEHA Commercial |
$6,230.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,010.90
|
| Rate for Payer: Multiplan All |
$8,099.91
|
| Rate for Payer: OMNI Networks Commercial |
$6,230.70
|
| Rate for Payer: One Health Plan PPO/POS |
$8,010.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,455.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,675.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,277.93
|
| Rate for Payer: Zelis Auto |
$3,560.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,429.97
|
|
|
STRAVIX 3X6CM
|
Facility
|
OP
|
$8,901.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7002932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$8,455.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,340.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$175.46
|
| Rate for Payer: Cash Price |
$5,340.60
|
| Rate for Payer: Cash Price |
$5,340.60
|
| Rate for Payer: Cigna Commercial |
$7,565.85
|
| Rate for Payer: First Health Commercial |
$8,010.90
|
| Rate for Payer: First Health Workers Compensation |
$3,436.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,010.90
|
| Rate for Payer: GEHA Commercial |
$152.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,010.90
|
| Rate for Payer: Humana ChoiceCare |
$2,314.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$179.04
|
| Rate for Payer: Multiplan All |
$8,099.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,340.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,230.70
|
| Rate for Payer: One Health Plan PPO/POS |
$8,010.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$206.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$179.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,455.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,675.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,832.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,277.93
|
| Rate for Payer: Zelis Auto |
$3,560.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,450.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,429.97
|
|
|
STRAVIX PRIME PL SQ CM 2X4
|
Facility
|
IP
|
$5,886.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7006645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,591.70 |
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cigna Commercial |
$5,003.10
|
| Rate for Payer: First Health Commercial |
$5,297.40
|
| Rate for Payer: First Health Workers Compensation |
$2,272.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,297.40
|
| Rate for Payer: GEHA Commercial |
$4,120.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,297.40
|
| Rate for Payer: Multiplan All |
$5,356.26
|
| Rate for Payer: OMNI Networks Commercial |
$4,120.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,297.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,591.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,414.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,473.98
|
| Rate for Payer: Zelis Auto |
$2,354.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,606.88
|
|
|
STRAVIX PRIME PL SQ CM 2X4
|
Facility
|
OP
|
$5,886.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7006645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$5,591.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,531.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$175.46
|
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cash Price |
$3,531.60
|
| Rate for Payer: Cigna Commercial |
$5,003.10
|
| Rate for Payer: First Health Commercial |
$5,297.40
|
| Rate for Payer: First Health Workers Compensation |
$2,272.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,297.40
|
| Rate for Payer: GEHA Commercial |
$152.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,297.40
|
| Rate for Payer: Humana ChoiceCare |
$1,530.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$179.04
|
| Rate for Payer: Multiplan All |
$5,356.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,531.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,120.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,297.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$206.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$179.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,591.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,414.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,179.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,473.98
|
| Rate for Payer: Zelis Auto |
$2,354.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,943.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,606.88
|
|
|
STRAVIX PRIME PL SQ CM 3X6
|
Facility
|
OP
|
$8,901.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7006646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$8,455.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,340.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$175.46
|
| Rate for Payer: Cash Price |
$5,340.60
|
| Rate for Payer: Cash Price |
$5,340.60
|
| Rate for Payer: Cigna Commercial |
$7,565.85
|
| Rate for Payer: First Health Commercial |
$8,010.90
|
| Rate for Payer: First Health Workers Compensation |
$3,436.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,010.90
|
| Rate for Payer: GEHA Commercial |
$152.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,010.90
|
| Rate for Payer: Humana ChoiceCare |
$2,314.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$179.04
|
| Rate for Payer: Multiplan All |
$8,099.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,340.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,230.70
|
| Rate for Payer: One Health Plan PPO/POS |
$8,010.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$206.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$179.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,455.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,675.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,832.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,277.93
|
| Rate for Payer: Zelis Auto |
$3,560.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,450.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,429.97
|
|
|
STRAVIX PRIME PL SQ CM 3X6
|
Facility
|
IP
|
$8,901.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
7006646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,429.97 |
| Max. Negotiated Rate |
$8,455.95 |
| Rate for Payer: Cash Price |
$5,340.60
|
| Rate for Payer: Cigna Commercial |
$7,565.85
|
| Rate for Payer: First Health Commercial |
$8,010.90
|
| Rate for Payer: First Health Workers Compensation |
$3,436.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,010.90
|
| Rate for Payer: GEHA Commercial |
$6,230.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,010.90
|
| Rate for Payer: Multiplan All |
$8,099.91
|
| Rate for Payer: OMNI Networks Commercial |
$6,230.70
|
| Rate for Payer: One Health Plan PPO/POS |
$8,010.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,455.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,675.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,277.93
|
| Rate for Payer: Zelis Auto |
$3,560.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,429.97
|
|
|
STREP A ASSAY W/OPTIC
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
8587880
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.53
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$140.80
|
| Rate for Payer: GEHA Medicare |
$16.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Humana ChoiceCare |
$18.18
|
| Rate for Payer: Humana Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.53
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.10
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.06
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.53
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Medicare |
$14.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
STREP A ASSAY W/OPTIC
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
21600329
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.53
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$140.80
|
| Rate for Payer: GEHA Medicare |
$16.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Humana ChoiceCare |
$18.18
|
| Rate for Payer: Humana Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.53
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.10
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.06
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.53
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Medicare |
$14.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
STREP A ASSAY W/OPTIC
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
21600329
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
STREP A ASSAY W/OPTIC
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
8587880
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
STREPT PNEUMONIAE AB IGG 12 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 12 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 12 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 12 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 14 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 14 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 14 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
