|
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
|
|
|
codfish, IgE REF602465
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| 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 |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
codfish, IgE REF602465
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299194
|
|
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
|
|
|
CO DIFFUSING CAPACITY
|
Facility
|
OP
|
$652.54
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4094729
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$619.91 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$391.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.33
|
| Rate for Payer: Cash Price |
$391.52
|
| Rate for Payer: Cash Price |
$391.52
|
| Rate for Payer: Cigna Commercial |
$554.66
|
| Rate for Payer: First Health Commercial |
$587.29
|
| Rate for Payer: First Health Workers Compensation |
$251.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$587.29
|
| Rate for Payer: GEHA Commercial |
$522.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$587.29
|
| Rate for Payer: Humana ChoiceCare |
$169.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$72.79
|
| Rate for Payer: Multiplan All |
$593.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$391.52
|
| Rate for Payer: OMNI Networks Commercial |
$456.78
|
| Rate for Payer: One Health Plan PPO/POS |
$587.29
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$84.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$72.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.91
|
| Rate for Payer: Three Rivers Provider Network All |
$489.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$574.24
|
| Rate for Payer: United Healthcare Commercial |
$554.66
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.86
|
| Rate for Payer: Zelis Auto |
$261.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$326.27
|
| Rate for Payer: Zelis Worker's Compensation |
$178.14
|
|
|
CO DIFFUSING CAPACITY
|
Facility
|
IP
|
$652.54
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4094729
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$178.14 |
| Max. Negotiated Rate |
$619.91 |
| Rate for Payer: Cash Price |
$391.52
|
| Rate for Payer: Cigna Commercial |
$554.66
|
| Rate for Payer: First Health Commercial |
$587.29
|
| Rate for Payer: First Health Workers Compensation |
$251.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$587.29
|
| Rate for Payer: GEHA Commercial |
$456.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$587.29
|
| Rate for Payer: Multiplan All |
$593.81
|
| Rate for Payer: OMNI Networks Commercial |
$456.78
|
| Rate for Payer: One Health Plan PPO/POS |
$587.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.91
|
| Rate for Payer: Three Rivers Provider Network All |
$489.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.86
|
| Rate for Payer: Zelis Auto |
$261.02
|
| Rate for Payer: Zelis Worker's Compensation |
$178.14
|
|
|
coenzyme q10 total REF120251
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$207.10 |
| 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 |
$130.80
|
| 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 |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$24.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| 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 |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| 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 |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.18
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| 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 |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.09
|
| Rate for Payer: Zelis Auto |
$87.20
|
| 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
|
|
|
coenzyme q10 total REF120251
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
COLCHICINE 0.6MG
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
NDC 00904673204
|
| Hospital Charge Code |
3300203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
COLCHICINE 0.6MG
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
NDC 00904673204
|
| Hospital Charge Code |
3300203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Humana ChoiceCare |
$10.66
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.60
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
cold agglutinin titer, quant REF006353
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
2200615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$106.25
|
| Rate for Payer: First Health Commercial |
$112.50
|
| Rate for Payer: First Health Workers Compensation |
$12.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$112.50
|
| Rate for Payer: GEHA Commercial |
$100.00
|
| Rate for Payer: GEHA Medicare |
$8.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$112.50
|
| Rate for Payer: Humana ChoiceCare |
$8.87
|
| Rate for Payer: Humana Medicare Advantage |
$8.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.06
|
| Rate for Payer: Multiplan All |
$113.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.70
|
| Rate for Payer: OMNI Networks Commercial |
$87.50
|
| Rate for Payer: One Health Plan PPO/POS |
$112.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$118.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.12
|
| Rate for Payer: Three Rivers Provider Network All |
$93.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.90
|
| Rate for Payer: United Healthcare Commercial |
$106.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$116.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.06
|
| Rate for Payer: Zelis Auto |
$50.00
|
| Rate for Payer: Zelis Medicare |
$6.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.67
|
| Rate for Payer: Zelis Worker's Compensation |
$8.76
|
|
|
cold agglutinin titer, quant REF006353
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
2200615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$106.25
|
| Rate for Payer: First Health Commercial |
$112.50
|
| Rate for Payer: First Health Workers Compensation |
$12.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$112.50
|
| Rate for Payer: GEHA Commercial |
$87.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$112.50
|
| Rate for Payer: Multiplan All |
$113.75
|
| Rate for Payer: OMNI Networks Commercial |
$87.50
|
| Rate for Payer: One Health Plan PPO/POS |
$112.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$118.75
|
| Rate for Payer: Three Rivers Provider Network All |
$93.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$116.25
|
| Rate for Payer: Zelis Auto |
$50.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.76
|
|
|
COLECTOMY W/ILEOANAL ANAST
|
Facility
|
IP
|
$4,519.00
|
|
|
Service Code
|
CPT 44157
|
| Hospital Charge Code |
6144157
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,233.69 |
| Max. Negotiated Rate |
$4,293.05 |
| Rate for Payer: Cash Price |
$2,711.40
|
| Rate for Payer: Cigna Commercial |
$3,841.15
|
| Rate for Payer: First Health Commercial |
$4,067.10
|
| Rate for Payer: First Health Workers Compensation |
$1,744.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,067.10
|
| Rate for Payer: GEHA Commercial |
$3,163.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,067.10
|
| Rate for Payer: Multiplan All |
$4,112.29
|
| Rate for Payer: OMNI Networks Commercial |
$3,163.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,067.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,293.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,202.67
|
| Rate for Payer: Zelis Auto |
$1,807.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,233.69
|
|
|
COLECTOMY W/ILEOANAL ANAST
|
Facility
|
OP
|
$4,519.00
|
|
|
Service Code
|
CPT 44157
|
| Hospital Charge Code |
6144157
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,129.75 |
| Max. Negotiated Rate |
$4,293.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,711.40
|
| Rate for Payer: Cash Price |
$2,711.40
|
| Rate for Payer: Cigna Commercial |
$3,841.15
|
| Rate for Payer: First Health Commercial |
$4,067.10
|
| Rate for Payer: First Health Workers Compensation |
$1,744.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,067.10
|
| Rate for Payer: GEHA Commercial |
$3,615.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,067.10
|
| Rate for Payer: Humana ChoiceCare |
$1,174.94
|
| Rate for Payer: Multiplan All |
$4,112.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,711.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,163.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,067.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,293.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,976.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,202.67
|
| Rate for Payer: Zelis Auto |
$1,807.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,259.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,233.69
|
|
|
COLECTOMY W/NEO-RECTUM POUCH
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
CPT 44158
|
| Hospital Charge Code |
6144158
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,210.76 |
| Max. Negotiated Rate |
$4,213.25 |
| Rate for Payer: Cash Price |
$2,661.00
|
| Rate for Payer: Cigna Commercial |
$3,769.75
|
| Rate for Payer: First Health Commercial |
$3,991.50
|
| Rate for Payer: First Health Workers Compensation |
$1,712.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,991.50
|
| Rate for Payer: GEHA Commercial |
$3,104.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,991.50
|
| Rate for Payer: Multiplan All |
$4,035.85
|
| Rate for Payer: OMNI Networks Commercial |
$3,104.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,991.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,213.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,326.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,124.55
|
| Rate for Payer: Zelis Auto |
$1,774.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,210.76
|
|
|
COLECTOMY W/NEO-RECTUM POUCH
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
CPT 44158
|
| Hospital Charge Code |
6144158
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,108.75 |
| Max. Negotiated Rate |
$4,213.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,661.00
|
| Rate for Payer: Cash Price |
$2,661.00
|
| Rate for Payer: Cigna Commercial |
$3,769.75
|
| Rate for Payer: First Health Commercial |
$3,991.50
|
| Rate for Payer: First Health Workers Compensation |
$1,712.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,991.50
|
| Rate for Payer: GEHA Commercial |
$3,548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,991.50
|
| Rate for Payer: Humana ChoiceCare |
$1,153.10
|
| Rate for Payer: Multiplan All |
$4,035.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,661.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,104.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,991.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,213.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,326.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,902.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,124.55
|
| Rate for Payer: Zelis Auto |
$1,774.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,217.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,210.76
|
|
|
COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
7836592
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
7836592
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| 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 |
$50.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$263.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
2209998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| 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 |
$50.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
24500034
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
24700034
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| 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 |
$50.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$59.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
6180025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
8150102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
2209998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
8150102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
24700034
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
