|
URINE FLOW MEASUREMENT
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 51736
|
| Hospital Charge Code |
6151736
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.99 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: First Health Workers Compensation |
$494.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$897.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
| Rate for Payer: Zelis Worker's Compensation |
$349.99
|
|
|
URINE FLOW MEASUREMENT
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 51736
|
| Hospital Charge Code |
6151736
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$769.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: First Health Workers Compensation |
$494.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$1,025.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$512.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$349.99
|
|
|
URINE FLOW MEASUREMENT
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 51736
|
| Hospital Charge Code |
23551736
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
URINE FLOW MEASUREMENT
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 51736
|
| Hospital Charge Code |
23551736
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
urine GHB screen 738792
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
urine GHB screen 738792
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
URINE PH POP
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2299382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$6.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$3.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$3.94
|
| Rate for Payer: Humana Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.58
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.09
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.16
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.51
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.58
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$3.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.30
|
| Rate for Payer: Zelis Worker's Compensation |
$4.35
|
|
|
URINE PH POP
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2299382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$6.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$4.35
|
|
|
URINE PREGNANCY TEST
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
25500037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
21600037
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
21581025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
25500037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
21581025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
8581025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$144.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
8581025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
21600037
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
7281025
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PREGNANCY TEST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
7281025
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
URINE PROTEIN 24H (Vitros)
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
2232242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
URINE PROTEIN 24H (Vitros)
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
2232242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$3.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$4.04
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.67
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.24
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.34
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.67
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$3.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
urine protein electrphore rand REF354928
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
22990371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$42.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.31
|
|
|
urine protein electrphore rand REF354928
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
22990371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$42.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: GEHA Medicare |
$17.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$19.61
|
| Rate for Payer: Humana Medicare Advantage |
$17.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.83
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.31
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.66
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.47
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.83
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$15.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.31
|
|
|
urine protein electrphrss 24hr REF003368
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2247463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: First Health Workers Compensation |
$42.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$17.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$19.61
|
| Rate for Payer: Humana Medicare Advantage |
$17.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.83
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.31
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.66
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.47
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.83
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$15.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.31
|
|
|
urine protein electrphrss 24hr REF003368
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2247463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: First Health Workers Compensation |
$42.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$158.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.31
|
|
|
URINE PROTEIN RANDOM
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
2204180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
