|
varicella zoster ab IgG REF096206
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
2299171
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$20.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.63
|
|
|
varicella zoster ab IgG REF096206
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
2299171
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$20.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: GEHA Medicare |
$12.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$14.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.88
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.90
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.76
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.88
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Medicare |
$10.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.46
|
| Rate for Payer: Zelis Worker's Compensation |
$14.63
|
|
|
varicella zoster virus ab IgM REF096776
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
2299542
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$20.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.63
|
|
|
varicella zoster virus ab IgM REF096776
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
2299542
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$20.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: GEHA Medicare |
$12.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$14.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.88
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.90
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.76
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.88
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Medicare |
$10.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.46
|
| Rate for Payer: Zelis Worker's Compensation |
$14.63
|
|
|
varicella zoster virus dna,pcr REF138313
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2200059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
varicella zoster virus dna,pcr REF138313
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2200059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
VASC GRAFT INTO CARPAL BONE
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT 25430
|
| Hospital Charge Code |
6125430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.13 |
| Max. Negotiated Rate |
$1,420.25 |
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,270.75
|
| Rate for Payer: First Health Commercial |
$1,345.50
|
| Rate for Payer: First Health Workers Compensation |
$577.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,345.50
|
| Rate for Payer: GEHA Commercial |
$1,046.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,345.50
|
| Rate for Payer: Multiplan All |
$1,360.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,046.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,345.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,420.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,121.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,390.35
|
| Rate for Payer: Zelis Auto |
$598.00
|
| Rate for Payer: Zelis Worker's Compensation |
$408.13
|
|
|
VASC GRAFT INTO CARPAL BONE
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT 25430
|
| Hospital Charge Code |
6125430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.13 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$897.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,270.75
|
| Rate for Payer: First Health Commercial |
$1,345.50
|
| Rate for Payer: First Health Workers Compensation |
$577.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,345.50
|
| Rate for Payer: GEHA Commercial |
$1,196.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,345.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,360.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,046.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,345.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,420.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,121.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,390.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$598.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$408.13
|
|
|
VASCULAR ACCESS DEVICE DRAW
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
1936592
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
VASCULAR ACCESS DEVICE DRAW
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
1936592
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| 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 |
$50.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$263.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
vascular endothelial grow fact REF117021
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
vascular endothelial grow fact REF117021
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
6155250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.01 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$424.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$600.95
|
| Rate for Payer: First Health Commercial |
$636.30
|
| Rate for Payer: First Health Workers Compensation |
$272.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$636.30
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$636.30
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$643.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$494.90
|
| Rate for Payer: One Health Plan PPO/POS |
$636.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$671.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$530.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$657.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$282.80
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$193.01
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
6155250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.01 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$600.95
|
| Rate for Payer: First Health Commercial |
$636.30
|
| Rate for Payer: First Health Workers Compensation |
$272.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$636.30
|
| Rate for Payer: GEHA Commercial |
$494.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$636.30
|
| Rate for Payer: Multiplan All |
$643.37
|
| Rate for Payer: OMNI Networks Commercial |
$494.90
|
| Rate for Payer: One Health Plan PPO/POS |
$636.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$671.65
|
| Rate for Payer: Three Rivers Provider Network All |
$530.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$657.51
|
| Rate for Payer: Zelis Auto |
$282.80
|
| Rate for Payer: Zelis Worker's Compensation |
$193.01
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM
|
Facility
|
OP
|
$6,283.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
20355250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,653.37 |
| Max. Negotiated Rate |
$5,968.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,769.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$3,769.80
|
| Rate for Payer: Cash Price |
$3,769.80
|
| Rate for Payer: Cigna Commercial |
$5,340.55
|
| Rate for Payer: First Health Commercial |
$5,654.70
|
| Rate for Payer: First Health Workers Compensation |
$2,425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,654.70
|
| Rate for Payer: GEHA Commercial |
$5,026.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,654.70
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$5,717.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$4,398.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,654.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,968.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$4,712.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,843.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$2,513.20
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,715.26
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM
|
Facility
|
IP
|
$6,283.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
20355250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,715.26 |
| Max. Negotiated Rate |
$5,968.85 |
| Rate for Payer: Cash Price |
$3,769.80
|
| Rate for Payer: Cigna Commercial |
$5,340.55
|
| Rate for Payer: First Health Commercial |
$5,654.70
|
| Rate for Payer: First Health Workers Compensation |
$2,425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,654.70
|
| Rate for Payer: GEHA Commercial |
$4,398.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,654.70
|
| Rate for Payer: Multiplan All |
$5,717.53
|
| Rate for Payer: OMNI Networks Commercial |
$4,398.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,654.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,968.85
|
| Rate for Payer: Three Rivers Provider Network All |
$4,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,843.19
|
| Rate for Payer: Zelis Auto |
$2,513.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,715.26
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9200015
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$793.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAM
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9200015
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$680.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$3,890.28
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,653.37 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: First Health Workers Compensation |
$2,503.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,770.08
|
|
|
VASOPRESSIN 20 UNIT/1 ML SDV
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
3300936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: First Health Commercial |
$748.80
|
| Rate for Payer: First Health Workers Compensation |
$321.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$748.80
|
| Rate for Payer: GEHA Commercial |
$665.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$748.80
|
| Rate for Payer: Humana ChoiceCare |
$216.32
|
| Rate for Payer: Multiplan All |
$757.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$499.20
|
| Rate for Payer: OMNI Networks Commercial |
$582.40
|
| Rate for Payer: One Health Plan PPO/POS |
$748.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$790.40
|
| Rate for Payer: Three Rivers Provider Network All |
$624.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$732.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$773.76
|
| Rate for Payer: Zelis Auto |
$332.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$416.00
|
| Rate for Payer: Zelis Worker's Compensation |
$227.14
|
|
|
VASOPRESSIN 20 UNIT/1 ML SDV
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
NDC 42023016425
|
| Hospital Charge Code |
3300936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$227.14 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: First Health Commercial |
$748.80
|
| Rate for Payer: First Health Workers Compensation |
$321.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$748.80
|
| Rate for Payer: GEHA Commercial |
$582.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$748.80
|
| Rate for Payer: Multiplan All |
$757.12
|
| Rate for Payer: OMNI Networks Commercial |
$582.40
|
| Rate for Payer: One Health Plan PPO/POS |
$748.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$790.40
|
| Rate for Payer: Three Rivers Provider Network All |
$624.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$773.76
|
| Rate for Payer: Zelis Auto |
$332.80
|
| Rate for Payer: Zelis Worker's Compensation |
$227.14
|
|
|
vdrl csf REF006445
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
2200456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.68
|
| 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 |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.27
|
| 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 |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$4.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$4.70
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.27
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.26
|
| 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 |
$7.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.54
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.18
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.27
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$3.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.12
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
vdrl csf REF006445
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
2200456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.31 |
| 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 |
$7.51
|
| 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 |
$5.31
|
|
|
vectra REF504965
|
Facility
|
OP
|
$840.65
|
|
|
Service Code
|
CPT 81490
|
| Hospital Charge Code |
2200844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$336.26 |
| Max. Negotiated Rate |
$1,681.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,260.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,260.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$998.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$840.65
|
| Rate for Payer: Cash Price |
$504.39
|
| Rate for Payer: Cash Price |
$504.39
|
| Rate for Payer: Cigna Commercial |
$714.55
|
| Rate for Payer: First Health Commercial |
$756.59
|
| Rate for Payer: First Health Workers Compensation |
$950.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.59
|
| Rate for Payer: GEHA Commercial |
$672.52
|
| Rate for Payer: GEHA Medicare |
$840.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.59
|
| Rate for Payer: Humana ChoiceCare |
$924.72
|
| Rate for Payer: Humana Medicare Advantage |
$840.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,412.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,019.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$840.65
|
| Rate for Payer: Multiplan All |
$764.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,429.11
|
| Rate for Payer: OMNI Networks Commercial |
$588.46
|
| Rate for Payer: One Health Plan PPO/POS |
$756.59
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,176.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,019.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$840.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,681.30
|
| Rate for Payer: Three Rivers Provider Network All |
$630.49
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$823.84
|
| Rate for Payer: United Healthcare Commercial |
$714.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,019.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$840.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$840.65
|
| Rate for Payer: Zelis Auto |
$336.26
|
| Rate for Payer: Zelis Medicare |
$714.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,008.78
|
| Rate for Payer: Zelis Worker's Compensation |
$671.92
|
|
|
vectra REF504965
|
Facility
|
IP
|
$840.65
|
|
|
Service Code
|
CPT 81490
|
| Hospital Charge Code |
2200844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$336.26 |
| Max. Negotiated Rate |
$950.29 |
| Rate for Payer: Cash Price |
$504.39
|
| Rate for Payer: Cash Price |
$504.39
|
| Rate for Payer: Cigna Commercial |
$714.55
|
| Rate for Payer: First Health Commercial |
$756.59
|
| Rate for Payer: First Health Workers Compensation |
$950.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.59
|
| Rate for Payer: GEHA Commercial |
$588.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.59
|
| Rate for Payer: Multiplan All |
$764.99
|
| Rate for Payer: OMNI Networks Commercial |
$588.46
|
| Rate for Payer: One Health Plan PPO/POS |
$756.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.62
|
| Rate for Payer: Three Rivers Provider Network All |
$630.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.80
|
| Rate for Payer: Zelis Auto |
$336.26
|
| Rate for Payer: Zelis Worker's Compensation |
$671.92
|
|
