|
ZONISAMIDE REF
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
2200079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$23.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.41
|
|
|
ZOSTER VACC, SC
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
8590736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$317.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Humana ChoiceCare |
$103.22
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$238.20
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$349.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$99.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$198.50
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
ZOSTER VACC, SC
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
8590736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$277.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
ZOSTER VACC, SC
|
Facility
|
IP
|
$602.75
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
7290736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.55 |
| Max. Negotiated Rate |
$572.61 |
| Rate for Payer: Cash Price |
$361.65
|
| Rate for Payer: Cigna Commercial |
$512.34
|
| Rate for Payer: First Health Commercial |
$542.48
|
| Rate for Payer: First Health Workers Compensation |
$232.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.48
|
| Rate for Payer: GEHA Commercial |
$421.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.48
|
| Rate for Payer: Multiplan All |
$548.50
|
| Rate for Payer: OMNI Networks Commercial |
$421.93
|
| Rate for Payer: One Health Plan PPO/POS |
$542.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.61
|
| Rate for Payer: Three Rivers Provider Network All |
$452.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.56
|
| Rate for Payer: Zelis Auto |
$241.10
|
| Rate for Payer: Zelis Worker's Compensation |
$164.55
|
|
|
ZOSTER VACC, SC
|
Facility
|
OP
|
$602.75
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
7290736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.69 |
| Max. Negotiated Rate |
$572.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.65
|
| Rate for Payer: Cash Price |
$361.65
|
| Rate for Payer: Cigna Commercial |
$512.34
|
| Rate for Payer: First Health Commercial |
$542.48
|
| Rate for Payer: First Health Workers Compensation |
$232.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.48
|
| Rate for Payer: GEHA Commercial |
$482.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.48
|
| Rate for Payer: Humana ChoiceCare |
$156.72
|
| Rate for Payer: Multiplan All |
$548.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.65
|
| Rate for Payer: OMNI Networks Commercial |
$421.93
|
| Rate for Payer: One Health Plan PPO/POS |
$542.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.61
|
| Rate for Payer: Three Rivers Provider Network All |
$452.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$530.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.56
|
| Rate for Payer: Zelis Auto |
$241.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.38
|
| Rate for Payer: Zelis Worker's Compensation |
$164.55
|
|
|
ZURINE RANDOM METANEPHRINES FRACTIONATED
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
22990741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$30.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$288.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Worker's Compensation |
$21.43
|
|
|
ZURINE RANDOM METANEPHRINES FRACTIONATED
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
22990741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$30.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$329.60
|
| Rate for Payer: GEHA Medicare |
$16.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Humana ChoiceCare |
$18.63
|
| Rate for Payer: Humana Medicare Advantage |
$16.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.94
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.80
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.88
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.60
|
| Rate for Payer: United Healthcare Commercial |
$350.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.94
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Medicare |
$14.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.33
|
| Rate for Payer: Zelis Worker's Compensation |
$21.43
|
|
|
zzHELICOBACER PYLORI STOOL AG REF
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
2200153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$340.00
|
| Rate for Payer: GEHA Medicare |
$14.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Humana ChoiceCare |
$15.82
|
| Rate for Payer: Humana Medicare Advantage |
$14.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.38
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.45
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.76
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.09
|
| Rate for Payer: United Healthcare Commercial |
$361.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.38
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Medicare |
$12.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.26
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
zzHELICOBACER PYLORI STOOL AG REF
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
2200153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$297.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
ZZIGF2 LC/MS
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
22990800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: First Health Commercial |
$198.00
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.00
|
| Rate for Payer: GEHA Commercial |
$176.00
|
| Rate for Payer: GEHA Medicare |
$24.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.00
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Humana Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.11
|
| Rate for Payer: Multiplan All |
$200.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.99
|
| Rate for Payer: OMNI Networks Commercial |
$154.00
|
| Rate for Payer: One Health Plan PPO/POS |
$198.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.22
|
| Rate for Payer: Three Rivers Provider Network All |
$165.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.63
|
| Rate for Payer: United Healthcare Commercial |
$187.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$204.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.11
|
| Rate for Payer: Zelis Auto |
$88.00
|
| Rate for Payer: Zelis Medicare |
$20.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.93
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
ZZIGF2 LC/MS
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
22990800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: First Health Commercial |
$198.00
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.00
|
| Rate for Payer: GEHA Commercial |
$154.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.00
|
| Rate for Payer: Multiplan All |
$200.20
|
| Rate for Payer: OMNI Networks Commercial |
$154.00
|
| Rate for Payer: One Health Plan PPO/POS |
$198.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.00
|
| Rate for Payer: Three Rivers Provider Network All |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$204.60
|
| Rate for Payer: Zelis Auto |
$88.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
ZZRITUXAN SENSITIVITY (CD20)
|
Facility
|
IP
|
$188.00
|
|
| Hospital Charge Code |
22990770
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$72.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$131.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Worker's Compensation |
$51.32
|
|
|
ZZRITUXAN SENSITIVITY (CD20)
|
Facility
|
OP
|
$188.00
|
|
| Hospital Charge Code |
22990770
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$72.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$150.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Humana ChoiceCare |
$48.88
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$112.80
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.44
|
| Rate for Payer: United Healthcare Commercial |
$159.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.00
|
| Rate for Payer: Zelis Worker's Compensation |
$51.32
|
|
|
ZZtotal protein serum/plasma REF001073
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
22990851
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$118.40
|
| Rate for Payer: GEHA Medicare |
$3.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Humana ChoiceCare |
$4.04
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.67
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.24
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.34
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$125.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.67
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Medicare |
$3.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
ZZtotal protein serum/plasma REF001073
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
22990851
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$103.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
ZZZDNA ds AB
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
22990338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$27.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$13.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$15.11
|
| Rate for Payer: Humana Medicare Advantage |
$13.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.74
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.36
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.48
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.74
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$11.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.49
|
| Rate for Payer: Zelis Worker's Compensation |
$19.64
|
|
|
ZZZDNA ds AB
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
22990338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$27.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.64
|
|
