|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
9699351
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
23099398
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
9400039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7236415
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: First Health Commercial |
$24.30
|
| Rate for Payer: First Health Workers Compensation |
$10.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24.30
|
| Rate for Payer: GEHA Commercial |
$18.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24.30
|
| Rate for Payer: Multiplan All |
$24.57
|
| Rate for Payer: OMNI Networks Commercial |
$18.90
|
| Rate for Payer: One Health Plan PPO/POS |
$24.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25.65
|
| Rate for Payer: Three Rivers Provider Network All |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25.11
|
| Rate for Payer: Zelis Auto |
$10.80
|
| Rate for Payer: Zelis Worker's Compensation |
$7.37
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
8299216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
21999423
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
9399223
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
8099284
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7636415
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
9099223
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
8399246
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
8299216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
21600081
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: First Health Commercial |
$24.30
|
| Rate for Payer: First Health Workers Compensation |
$10.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24.30
|
| Rate for Payer: GEHA Commercial |
$21.60
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24.30
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$24.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$18.90
|
| Rate for Payer: One Health Plan PPO/POS |
$24.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$20.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$10.80
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$7.37
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
8899227
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
6180026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: First Health Commercial |
$24.30
|
| Rate for Payer: First Health Workers Compensation |
$10.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24.30
|
| Rate for Payer: GEHA Commercial |
$21.60
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24.30
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$24.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$18.90
|
| Rate for Payer: One Health Plan PPO/POS |
$24.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$20.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Commercial |
$22.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$10.80
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$7.37
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7599223
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
9100001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
21099503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$9.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$10.00
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.09
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.45
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.18
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.09
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$7.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21099091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21599091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21799091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21599091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21600048
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21799091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
COLLJ&INTERPJ PHY/QHP PHYSIO COMP 30 MIN
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
21900175
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
