|
viral culture general REF008573
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246135
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.20
|
| 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 |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.56
|
| 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 |
$24.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$19.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$21.52
|
| Rate for Payer: Humana Medicare Advantage |
$19.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.56
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.25
|
| 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 |
$32.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.12
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.17
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.56
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$16.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.47
|
| Rate for Payer: Zelis Worker's Compensation |
$17.18
|
|
|
viral culture general REF008573
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246135
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.18 |
| 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 |
$24.30
|
| 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 |
$17.18
|
|
|
Viral Culture ParaInfluenza1
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.18 |
| 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 |
$24.30
|
| 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 |
$17.18
|
|
|
Viral Culture ParaInfluenza1
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.20
|
| 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 |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.56
|
| 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 |
$24.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$19.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$21.52
|
| Rate for Payer: Humana Medicare Advantage |
$19.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.56
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.25
|
| 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 |
$32.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.12
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.17
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.56
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$16.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.47
|
| Rate for Payer: Zelis Worker's Compensation |
$17.18
|
|
|
Viral Culture Parainfluenza 2 REF
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246139
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.18 |
| 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 |
$24.30
|
| 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 |
$17.18
|
|
|
Viral Culture Parainfluenza 2 REF
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246139
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.20
|
| 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 |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.56
|
| 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 |
$24.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$19.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$21.52
|
| Rate for Payer: Humana Medicare Advantage |
$19.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.56
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.25
|
| 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 |
$32.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.12
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.17
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.56
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$16.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.47
|
| Rate for Payer: Zelis Worker's Compensation |
$17.18
|
|
|
Viral Culture ParaInfluenza 3
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.18 |
| 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 |
$24.30
|
| 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 |
$17.18
|
|
|
Viral Culture ParaInfluenza 3
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.20
|
| 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 |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.56
|
| 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 |
$24.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$19.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$21.52
|
| Rate for Payer: Humana Medicare Advantage |
$19.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.56
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.25
|
| 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 |
$32.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.12
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.17
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.56
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$16.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.47
|
| Rate for Payer: Zelis Worker's Compensation |
$17.18
|
|
|
Viral Culture Respiratory Synctial Virus
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.18 |
| 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 |
$24.30
|
| 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 |
$17.18
|
|
|
Viral Culture Respiratory Synctial Virus
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2246141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.20
|
| 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 |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.56
|
| 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 |
$24.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: GEHA Medicare |
$19.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$21.52
|
| Rate for Payer: Humana Medicare Advantage |
$19.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.56
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.25
|
| 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 |
$32.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.12
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.17
|
| Rate for Payer: United Healthcare Commercial |
$192.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.56
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Medicare |
$16.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.47
|
| Rate for Payer: Zelis Worker's Compensation |
$17.18
|
|
|
viscosity serum REF004861
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
2299566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.59
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$16.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$18.25
|
| Rate for Payer: Humana Medicare Advantage |
$16.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.59
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.18
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.59
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$14.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.91
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
viscosity serum REF004861
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
2299566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
VISIPAQUE 320MGI/ML 100ML
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3302887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: First Health Workers Compensation |
$266.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Humana ChoiceCare |
$179.40
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.00
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$607.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: Zelis Auto |
$276.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.00
|
| Rate for Payer: Zelis Worker's Compensation |
$188.37
|
|
|
VISIPAQUE 320MGI/ML 100ML
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3302887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: First Health Workers Compensation |
$266.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$483.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: Zelis Auto |
$276.00
|
| Rate for Payer: Zelis Worker's Compensation |
$188.37
|
|
|
VISUAL EP TEST FOR GLAUCOMA
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 0464T
|
| Hospital Charge Code |
6191091
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$74.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Worker's Compensation |
$52.69
|
|
|
VISUAL EP TEST FOR GLAUCOMA
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 0464T
|
| Hospital Charge Code |
6191091
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$150.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$74.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$177.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$154.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$154.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$52.69
|
|
|
VISUALIZATION OF WINDPIPE
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
6131615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$338.30
|
| Rate for Payer: First Health Commercial |
$358.20
|
| Rate for Payer: First Health Workers Compensation |
$153.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$358.20
|
| Rate for Payer: GEHA Commercial |
$318.40
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$358.20
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$362.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$278.60
|
| Rate for Payer: One Health Plan PPO/POS |
$358.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$378.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$298.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$370.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$159.20
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$108.65
|
|
|
VISUALIZATION OF WINDPIPE
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
6131615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$338.30
|
| Rate for Payer: First Health Commercial |
$358.20
|
| Rate for Payer: First Health Workers Compensation |
$153.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$358.20
|
| Rate for Payer: GEHA Commercial |
$278.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$358.20
|
| Rate for Payer: Multiplan All |
$362.18
|
| Rate for Payer: OMNI Networks Commercial |
$278.60
|
| Rate for Payer: One Health Plan PPO/POS |
$358.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$378.10
|
| Rate for Payer: Three Rivers Provider Network All |
$298.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$370.14
|
| Rate for Payer: Zelis Auto |
$159.20
|
| Rate for Payer: Zelis Worker's Compensation |
$108.65
|
|
|
VITAL CAPACITY TESTING
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4094150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$125.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Commercial |
$276.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$88.72
|
|
|
VITAL CAPACITY TESTING
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4094150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$125.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$88.72
|
|
|
VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
21600122
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
21600122
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
vitamin a REF017509
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
2299172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.61
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$21.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$11.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$12.77
|
| Rate for Payer: Humana Medicare Advantage |
$11.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.61
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.74
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.22
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.61
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$9.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.93
|
| Rate for Payer: Zelis Worker's Compensation |
$15.49
|
|
|
vitamin a REF017509
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
2299172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$21.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.49
|
|
|
vitamin B12 REF 001503
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
2232256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$28.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: GEHA Medicare |
$15.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$16.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.08
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.64
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.16
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$201.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.08
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Medicare |
$12.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.10
|
| Rate for Payer: Zelis Worker's Compensation |
$20.48
|
|
