|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
6113102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$448.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$60.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$139.20
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$204.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$116.00
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
6113102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
cmv ab, IgG REF006494
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
2200451
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$14.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$15.83
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.39
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.46
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.78
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.39
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$12.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.27
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
cmv ab, IgG REF006494
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
2200451
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
cmv abs,IgM quali REF096727
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
2200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$25.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.10
|
|
|
cmv abs,IgM quali REF096727
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
2200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$25.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$16.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$18.54
|
| Rate for Payer: Humana Medicare Advantage |
$16.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.85
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.64
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.70
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.51
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.85
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$14.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.22
|
| Rate for Payer: Zelis Worker's Compensation |
$18.10
|
|
|
cmv pcr, qual REF138693
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
22990815
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$255.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
cmv pcr, qual REF138693
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
22990815
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$310.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
cmv, pcr quant, plasma REF139149
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
2299345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$69.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Humana ChoiceCare |
$47.12
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$71.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.84
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$396.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$49.15
|
|
|
cmv, pcr quant, plasma REF139149
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
2299345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.15 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$69.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$326.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.15
|
|
|
CNTRL POSTR NASL HEM,ANY METHD;INITIAL
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
8130905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$618.80
|
| Rate for Payer: First Health Commercial |
$655.20
|
| Rate for Payer: First Health Workers Compensation |
$281.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$655.20
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$655.20
|
| Rate for Payer: Multiplan All |
$662.48
|
| Rate for Payer: OMNI Networks Commercial |
$509.60
|
| Rate for Payer: One Health Plan PPO/POS |
$655.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$691.60
|
| Rate for Payer: Three Rivers Provider Network All |
$546.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.04
|
| Rate for Payer: Zelis Auto |
$291.20
|
| Rate for Payer: Zelis Worker's Compensation |
$198.74
|
|
|
CNTRL POSTR NASL HEM,ANY METHD;INITIAL
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
8130905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$436.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$618.80
|
| Rate for Payer: First Health Commercial |
$655.20
|
| Rate for Payer: First Health Workers Compensation |
$281.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$655.20
|
| Rate for Payer: GEHA Commercial |
$582.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$655.20
|
| 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 |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$662.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$509.60
|
| Rate for Payer: One Health Plan PPO/POS |
$655.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$691.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$546.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$291.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$198.74
|
|
|
CO2 OUTPUT/PERCENTAGE OXYGEN EXTRACTED
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
4094681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$648.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
CO2 OUTPUT/PERCENTAGE OXYGEN EXTRACTED
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
4094681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$741.60
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Commercial |
$787.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
COAPTITE,BULK AGENT 1ML.
|
Facility
|
IP
|
$2,188.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$597.37 |
| Max. Negotiated Rate |
$2,078.75 |
| Rate for Payer: Cash Price |
$1,312.90
|
| Rate for Payer: Cigna Commercial |
$1,859.94
|
| Rate for Payer: First Health Commercial |
$1,969.34
|
| Rate for Payer: First Health Workers Compensation |
$844.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,969.34
|
| Rate for Payer: GEHA Commercial |
$1,531.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,969.34
|
| Rate for Payer: Multiplan All |
$1,991.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,531.71
|
| Rate for Payer: One Health Plan PPO/POS |
$1,969.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,078.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,034.99
|
| Rate for Payer: Zelis Auto |
$875.26
|
| Rate for Payer: Zelis Worker's Compensation |
$597.37
|
|
|
COAPTITE,BULK AGENT 1ML.
|
Facility
|
OP
|
$2,188.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$547.04 |
| Max. Negotiated Rate |
$2,078.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,312.90
|
| Rate for Payer: Cash Price |
$1,312.90
|
| Rate for Payer: Cigna Commercial |
$1,859.94
|
| Rate for Payer: First Health Commercial |
$1,969.34
|
| Rate for Payer: First Health Workers Compensation |
$844.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,969.34
|
| Rate for Payer: GEHA Commercial |
$1,750.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,969.34
|
| Rate for Payer: Humana ChoiceCare |
$568.92
|
| Rate for Payer: Multiplan All |
$1,991.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,312.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,531.71
|
| Rate for Payer: One Health Plan PPO/POS |
$1,969.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,078.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,925.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$547.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,034.99
|
| Rate for Payer: Zelis Auto |
$875.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,094.08
|
| Rate for Payer: Zelis Worker's Compensation |
$597.37
|
|
|
COBALT BF, QUEST
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
2200336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$31.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.96
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$40.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: GEHA Medicare |
$21.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Humana ChoiceCare |
$24.16
|
| Rate for Payer: Humana Medicare Advantage |
$21.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$36.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.96
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.33
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$36.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$43.92
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.52
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.96
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Medicare |
$18.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.35
|
| Rate for Payer: Zelis Worker's Compensation |
$28.46
|
|
|
COBALT BF, QUEST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
2200336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$40.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.46
|
|
|
cobalt plasma REF071506
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
2200326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$40.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.46
|
|
|
cobalt plasma REF071506
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
2200326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$31.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.96
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$40.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: GEHA Medicare |
$21.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Humana ChoiceCare |
$24.16
|
| Rate for Payer: Humana Medicare Advantage |
$21.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$36.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.96
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.33
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$36.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$43.92
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.52
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.96
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Medicare |
$18.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.35
|
| Rate for Payer: Zelis Worker's Compensation |
$28.46
|
|
|
coccidiodes ab comp fixation REF139172
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
2200065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$18.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.15
|
|
|
coccidiodes ab comp fixation REF139172
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
2200065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$18.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$11.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$12.62
|
| Rate for Payer: Humana Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.47
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.50
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$22.94
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.24
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.47
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$9.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.76
|
| Rate for Payer: Zelis Worker's Compensation |
$13.15
|
|
|
COCCIDIOIDES AB COMP FIXATION REF
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
2300014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$18.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.15
|
|
|
COCCIDIOIDES AB COMP FIXATION REF
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
2300014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$18.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$11.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$12.62
|
| Rate for Payer: Humana Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.47
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.50
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$22.94
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.24
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.47
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$9.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.76
|
| Rate for Payer: Zelis Worker's Compensation |
$13.15
|
|
|
cockroach, american IgE REF602481
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
