|
CALCIUM GLUCONATE 10% INJ.- 1GM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT J0612
|
| Hospital Charge Code |
3300139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| 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 |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$0.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$28.86
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$97.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
calcium ionized REF004804
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
2282330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$26.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$13.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$13.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.68
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.26
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.36
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.41
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.68
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$11.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.42
|
| Rate for Payer: Zelis Worker's Compensation |
$18.48
|
|
|
calcium ionized REF004804
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
2282330
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$26.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.48
|
|
|
CALCIUM IONIZED VENOUS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
22990761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$26.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$13.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$13.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.68
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.26
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.36
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.41
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.68
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$11.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.42
|
| Rate for Payer: Zelis Worker's Compensation |
$18.48
|
|
|
CALCIUM IONIZED VENOUS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
22990761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$26.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.48
|
|
|
CALCIUM URINE POP
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
2299377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.03
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$10.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$6.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.03
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.25
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.06
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.03
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$5.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.24
|
| Rate for Payer: Zelis Worker's Compensation |
$7.72
|
|
|
CALCIUM URINE POP
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
2299377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$10.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.72
|
|
|
CALCIUM (Vitros)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2232197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
CALCIUM (Vitros)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2232197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$5.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Humana Medicare Advantage |
$5.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.16
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.77
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.32
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.16
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$4.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.19
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
CALCULATOR SPL-230 DIGIT
|
Facility
|
OP
|
$296.00
|
|
| Hospital Charge Code |
90030841
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$76.96
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.60
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$260.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
CALCULATOR SPL-230 DIGIT
|
Facility
|
IP
|
$296.00
|
|
| Hospital Charge Code |
90030841
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
calprotectin, stool REF123255
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
2200212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$35.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.63
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$29.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$292.80
|
| Rate for Payer: GEHA Medicare |
$19.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Humana ChoiceCare |
$21.59
|
| Rate for Payer: Humana Medicare Advantage |
$19.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.63
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.37
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.26
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.24
|
| Rate for Payer: United Healthcare Commercial |
$311.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.63
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Medicare |
$16.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.56
|
| Rate for Payer: Zelis Worker's Compensation |
$20.94
|
|
|
calprotectin, stool REF123255
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
2200212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$29.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$256.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.94
|
|
|
CALRETICULIN MUTATION ANALYSIS REF
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
2200078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$243.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$182.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$182.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$144.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$159.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$143.20
|
| Rate for Payer: GEHA Medicare |
$121.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Humana ChoiceCare |
$133.79
|
| Rate for Payer: Humana Medicare Advantage |
$121.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$204.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$147.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$121.63
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$206.77
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$170.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$147.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$121.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$243.26
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.20
|
| Rate for Payer: United Healthcare Commercial |
$152.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$121.63
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Medicare |
$103.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$145.96
|
| Rate for Payer: Zelis Worker's Compensation |
$112.91
|
|
|
CALRETICULIN MUTATION ANALYSIS REF
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
2200078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$159.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$125.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Worker's Compensation |
$112.91
|
|
|
CALTRATE TAB 600MG-800 UNIT
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00005550919
|
| Hospital Charge Code |
3300136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CALTRATE TAB 600MG-800 UNIT
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00005550919
|
| Hospital Charge Code |
3300136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Facility
|
IP
|
$238.57
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
8595992
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$226.64 |
| Rate for Payer: Cash Price |
$143.14
|
| Rate for Payer: Cigna Commercial |
$202.78
|
| Rate for Payer: First Health Commercial |
$214.71
|
| Rate for Payer: First Health Workers Compensation |
$92.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.71
|
| Rate for Payer: GEHA Commercial |
$167.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.71
|
| Rate for Payer: Multiplan All |
$217.10
|
| Rate for Payer: OMNI Networks Commercial |
$167.00
|
| Rate for Payer: One Health Plan PPO/POS |
$214.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.64
|
| Rate for Payer: Three Rivers Provider Network All |
$178.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.87
|
| Rate for Payer: Zelis Auto |
$95.43
|
| Rate for Payer: Zelis Worker's Compensation |
$65.13
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
21600232
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$142.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.81
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$34.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.20
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$116.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
21600232
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$92.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
21900165
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$142.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.81
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$34.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.20
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$116.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Facility
|
OP
|
$238.57
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
8595992
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$226.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.81
|
| Rate for Payer: Cash Price |
$143.14
|
| Rate for Payer: Cash Price |
$143.14
|
| Rate for Payer: Cigna Commercial |
$202.78
|
| Rate for Payer: First Health Commercial |
$214.71
|
| Rate for Payer: First Health Workers Compensation |
$92.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.71
|
| Rate for Payer: GEHA Commercial |
$190.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$62.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Multiplan All |
$217.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.14
|
| Rate for Payer: OMNI Networks Commercial |
$167.00
|
| Rate for Payer: One Health Plan PPO/POS |
$214.71
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.64
|
| Rate for Payer: Three Rivers Provider Network All |
$178.93
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$209.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.87
|
| Rate for Payer: Zelis Auto |
$95.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.28
|
| Rate for Payer: Zelis Worker's Compensation |
$65.13
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
21900165
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$92.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
candida 6 species profile REF180010
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
2299546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$99.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: GEHA Medicare |
$70.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$77.22
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$117.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$102.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$70.20
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.34
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$117.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$102.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$140.40
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$68.80
|
| Rate for Payer: United Healthcare Commercial |
$396.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$70.20
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Medicare |
$59.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.24
|
| Rate for Payer: Zelis Worker's Compensation |
$70.68
|
|
|
candida 6 species profile REF180010
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
2299546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$99.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.68
|
|
