|
1-4 YRS
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
7299382
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
15.5 OPENING DRILL
|
Facility
|
IP
|
$2,885.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,154.00 |
| Max. Negotiated Rate |
$2,740.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,308.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,452.25
|
| Rate for Payer: First Health Commercial |
$2,596.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,596.50
|
| Rate for Payer: GEHA Commercial |
$2,019.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,596.50
|
| Rate for Payer: Multiplan All |
$2,625.35
|
| Rate for Payer: OMNI Networks Commercial |
$2,019.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,596.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,740.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,163.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,683.05
|
| Rate for Payer: Zelis Auto |
$1,154.00
|
|
|
15.5 OPENING DRILL
|
Facility
|
OP
|
$2,885.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.25 |
| Max. Negotiated Rate |
$2,740.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,731.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,452.25
|
| Rate for Payer: First Health Commercial |
$2,596.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,596.50
|
| Rate for Payer: GEHA Commercial |
$2,308.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,596.50
|
| Rate for Payer: Humana ChoiceCare |
$750.10
|
| Rate for Payer: Multiplan All |
$2,625.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,731.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,019.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,596.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,740.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,163.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,538.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$721.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,683.05
|
| Rate for Payer: Zelis Auto |
$1,154.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,442.50
|
|
|
15 DAY REPORT INTERPRETATION
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
4093247
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: First Health Commercial |
$811.80
|
| Rate for Payer: First Health Workers Compensation |
$348.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$811.80
|
| Rate for Payer: GEHA Commercial |
$721.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$811.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$820.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$631.40
|
| Rate for Payer: One Health Plan PPO/POS |
$811.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$856.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$676.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$766.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$838.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$360.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$246.25
|
|
|
15 DAY REPORT INTERPRETATION
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
4093247
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$246.25 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: First Health Commercial |
$811.80
|
| Rate for Payer: First Health Workers Compensation |
$348.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$811.80
|
| Rate for Payer: GEHA Commercial |
$631.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$811.80
|
| Rate for Payer: Multiplan All |
$820.82
|
| Rate for Payer: OMNI Networks Commercial |
$631.40
|
| Rate for Payer: One Health Plan PPO/POS |
$811.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$856.90
|
| Rate for Payer: Three Rivers Provider Network All |
$676.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$838.86
|
| Rate for Payer: Zelis Auto |
$360.80
|
| Rate for Payer: Zelis Worker's Compensation |
$246.25
|
|
|
15 mCi IODINE I-131
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT A9517
|
| Hospital Charge Code |
2509517
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$590.23 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: First Health Workers Compensation |
$834.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Worker's Compensation |
$590.23
|
|
|
15 mCi IODINE I-131
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT A9517
|
| Hospital Charge Code |
2509517
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.13
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: First Health Workers Compensation |
$834.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: GEHA Medicare |
$23.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$25.44
|
| Rate for Payer: Humana Medicare Advantage |
$23.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$38.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.13
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.67
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.13
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Medicare |
$19.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.76
|
| Rate for Payer: Zelis Worker's Compensation |
$590.23
|
|
|
17000 CRYOTHERAPY - WART 1 SITE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
21517000
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$136.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
17000 CRYOTHERAPY - WART 1 SITE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
21517000
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$156.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
17003 CRYOTHERAPY - WART 2 THRU 14
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
21517003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
17003 CRYOTHERAPY - WART 2 THRU 14
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
21517003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
17004 CRYOTHERAPY - WART 15 OR MORE
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
21517004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
17004 CRYOTHERAPY - WART 15 OR MORE
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
21517004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
17110 WART FLAT 1-14
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
21517110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
17110 WART FLAT 1-14
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
21517110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
17 hydroxyprogesterone LCMS REF070085
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
2299675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27.17
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$47.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$166.40
|
| Rate for Payer: GEHA Medicare |
$27.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Humana ChoiceCare |
$29.89
|
| Rate for Payer: Humana Medicare Advantage |
$27.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$39.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27.17
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.19
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$39.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$54.34
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.63
|
| Rate for Payer: United Healthcare Commercial |
$176.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$27.17
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Medicare |
$23.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.80
|
|
|
17 hydroxyprogesterone LCMS REF070085
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
2299675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$47.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Worker's Compensation |
$33.80
|
|
|
18 - 39 YRS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
7299385
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
18 - 39 YRS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
7299385
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
18-39 YRS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
8599385
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
18-39 YRS
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
8599395
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Worker's Compensation |
$75.35
|
|
|
18-39 YRS
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
8599395
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$71.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.60
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$138.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.35
|
|
|
18-39 YRS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
8599385
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
18 hydroxycorticosterone REF500778
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
18 hydroxycorticosterone REF500778
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$24.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.09
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.18
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.09
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$20.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.91
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
