|
CHNG CYSTO TUBE COMPL - PROFEE
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
8111041
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$510.56 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$510.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: First Health Workers Compensation |
$858.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$601.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$520.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$606.88
|
|
|
CHNG CYSTO TUBE COMPL - PROFEE
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
8111041
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$606.88 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: First Health Workers Compensation |
$858.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Worker's Compensation |
$606.88
|
|
|
CHOLECALCIFEROL TAB 1000 UNIT
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 58487002371
|
| Hospital Charge Code |
3300177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CHOLECALCIFEROL TAB 1000 UNIT
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 58487002371
|
| Hospital Charge Code |
3300177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
6147490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.23 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$508.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$719.95
|
| Rate for Payer: First Health Commercial |
$762.30
|
| Rate for Payer: First Health Workers Compensation |
$327.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$762.30
|
| Rate for Payer: GEHA Commercial |
$677.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$762.30
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$770.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$592.90
|
| Rate for Payer: One Health Plan PPO/POS |
$762.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$804.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$635.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$787.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$338.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$231.23
|
|
|
CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
6147490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.23 |
| Max. Negotiated Rate |
$804.65 |
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$719.95
|
| Rate for Payer: First Health Commercial |
$762.30
|
| Rate for Payer: First Health Workers Compensation |
$327.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$762.30
|
| Rate for Payer: GEHA Commercial |
$592.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$762.30
|
| Rate for Payer: Multiplan All |
$770.77
|
| Rate for Payer: OMNI Networks Commercial |
$592.90
|
| Rate for Payer: One Health Plan PPO/POS |
$762.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$804.65
|
| Rate for Payer: Three Rivers Provider Network All |
$635.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$787.71
|
| Rate for Payer: Zelis Auto |
$338.80
|
| Rate for Payer: Zelis Worker's Compensation |
$231.23
|
|
|
CHOLESTEROL TOTAL (Vitros)
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
2232204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$74.40
|
| Rate for Payer: GEHA Medicare |
$4.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$4.79
|
| Rate for Payer: Humana Medicare Advantage |
$4.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.35
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.39
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.70
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.26
|
| Rate for Payer: United Healthcare Commercial |
$79.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.35
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Medicare |
$3.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.22
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
CHOLESTEROL TOTAL (Vitros)
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
2232204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
CHOLESTYRAMINE 4GM PACKET
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00245003642
|
| Hospital Charge Code |
3300178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CHOLESTYRAMINE 4GM PACKET
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00245003642
|
| Hospital Charge Code |
3300178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CHOLETEC DOSE 15MC
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
2410056
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: First Health Workers Compensation |
$133.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$89.70
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.00
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$303.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.50
|
| Rate for Payer: Zelis Worker's Compensation |
$94.19
|
|
|
CHOLETEC DOSE 15MC
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT A9537
|
| Hospital Charge Code |
2410056
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: First Health Workers Compensation |
$133.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.19
|
|
|
CHONDROPLASTY IN DIFFERENT COMPARTMENT
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT G0289
|
| Hospital Charge Code |
6100289
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$72.54
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$167.40
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$245.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.50
|
| Rate for Payer: Zelis Worker's Compensation |
$76.17
|
|
|
CHONDROPLASTY IN DIFFERENT COMPARTMENT
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT G0289
|
| Hospital Charge Code |
6100289
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.17 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$76.17
|
|
|
CHRNC CARE MGMT SVC 30 MIN
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9100013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$65.52
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.20
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$221.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
CHRNC CARE MGMT SVC 30 MIN
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9100013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
CHROMIUM BF, QUEST
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
2200335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.28
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$35.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: GEHA Medicare |
$20.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$22.31
|
| Rate for Payer: Humana Medicare Advantage |
$20.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.28
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.48
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.56
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.87
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.28
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Medicare |
$17.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.34
|
| Rate for Payer: Zelis Worker's Compensation |
$25.38
|
|
|
CHROMIUM BF, QUEST
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
2200335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$35.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.38
|
|
|
chromium, plasma REF071522
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
2200327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$35.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.38
|
|
|
chromium, plasma REF071522
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
2200327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.28
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$35.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: GEHA Medicare |
$20.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$22.31
|
| Rate for Payer: Humana Medicare Advantage |
$20.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.28
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.48
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.56
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.87
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.28
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Medicare |
$17.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.34
|
| Rate for Payer: Zelis Worker's Compensation |
$25.38
|
|
|
chromogranin A REF140848
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
22990737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.76 |
| 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 |
$33.60
|
| 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 |
$23.76
|
|
|
chromogranin A REF140848
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
22990737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| 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 |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| 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 |
$33.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| 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 |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$23.76
|
|
|
CHROMOSOME ANALYSIS 15-20 CELLS; 2 KARYO
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2200110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.67 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$125.49
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$219.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$1,079.20
|
| Rate for Payer: GEHA Medicare |
$125.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Humana ChoiceCare |
$138.04
|
| Rate for Payer: Humana Medicare Advantage |
$125.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$210.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$125.49
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$213.33
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$125.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$250.98
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.98
|
| Rate for Payer: United Healthcare Commercial |
$1,146.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$337.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$125.49
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Medicare |
$106.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$150.59
|
| Rate for Payer: Zelis Worker's Compensation |
$155.14
|
|
|
CHROMOSOME ANALYSIS 15-20 CELLS; 2 KARYO
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2200110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.14 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$219.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$944.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.14
|
|
|
CHROMOSOME ANALYSIS 20-25
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2200769
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$134.34 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$189.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$674.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Worker's Compensation |
$134.34
|
|
