|
CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
24500013
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$153.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$177.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$153.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Commercial |
$266.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
24500013
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
24700014
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
24500014
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$144.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
24500014
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
24700014
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$144.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
24500018
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
24700018
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
24500018
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
24700018
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-N
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
24700017
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-N
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
24700017
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-N
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
24500017
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-N
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
24500017
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
24700010
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
24700010
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$266.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$266.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Commercial |
$345.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
24500010
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
24500010
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$266.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$266.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Commercial |
$345.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHICKEN POX VACCINE, SC
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
8590716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
CHICKEN POX VACCINE, SC
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
8590716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$150.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$150.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$118.94
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$121.36
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.00
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$121.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
chlamydia antibodies, IgG REF096180
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
2200045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$18.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$11.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$13.00
|
| Rate for Payer: Humana Medicare Advantage |
$11.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.82
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.09
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.64
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.58
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.82
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$10.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.18
|
| Rate for Payer: Zelis Worker's Compensation |
$12.78
|
|
|
chlamydia antibodies, IgG REF096180
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
2200045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$18.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$12.78
|
|
|
chlamydia pneumoniae (IgG,IgM) REF138338
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
2200046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$18.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$12.78
|
|
|
chlamydia pneumoniae (IgG,IgM) REF138338
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
2200046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$18.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$11.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$13.00
|
| Rate for Payer: Humana Medicare Advantage |
$11.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.82
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.09
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.64
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.58
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.82
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$10.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.18
|
| Rate for Payer: Zelis Worker's Compensation |
$12.78
|
|
|
chlamydia pneumoniae pcr REF138263
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
2299740
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
