|
CORRECTION OF BUNION
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
6128296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$850.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,578.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,009.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,578.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$988.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$425.20
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$290.20
|
|
|
CORRECT MALROTATION OF BOWEL
|
Facility
|
IP
|
$3,145.00
|
|
|
Service Code
|
CPT 44055
|
| Hospital Charge Code |
6144055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$858.59 |
| Max. Negotiated Rate |
$2,987.75 |
| Rate for Payer: Cash Price |
$1,887.00
|
| Rate for Payer: Cigna Commercial |
$2,673.25
|
| Rate for Payer: First Health Commercial |
$2,830.50
|
| Rate for Payer: First Health Workers Compensation |
$1,214.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,830.50
|
| Rate for Payer: GEHA Commercial |
$2,201.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,830.50
|
| Rate for Payer: Multiplan All |
$2,861.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,201.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,830.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,987.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,358.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,924.85
|
| Rate for Payer: Zelis Auto |
$1,258.00
|
| Rate for Payer: Zelis Worker's Compensation |
$858.59
|
|
|
CORRECT MALROTATION OF BOWEL
|
Facility
|
OP
|
$3,145.00
|
|
|
Service Code
|
CPT 44055
|
| Hospital Charge Code |
6144055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$786.25 |
| Max. Negotiated Rate |
$2,987.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,887.00
|
| Rate for Payer: Cash Price |
$1,887.00
|
| Rate for Payer: Cigna Commercial |
$2,673.25
|
| Rate for Payer: First Health Commercial |
$2,830.50
|
| Rate for Payer: First Health Workers Compensation |
$1,214.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,830.50
|
| Rate for Payer: GEHA Commercial |
$2,516.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,830.50
|
| Rate for Payer: Humana ChoiceCare |
$817.70
|
| Rate for Payer: Multiplan All |
$2,861.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,887.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,201.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,830.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,987.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,358.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,767.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$786.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,924.85
|
| Rate for Payer: Zelis Auto |
$1,258.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,572.50
|
| Rate for Payer: Zelis Worker's Compensation |
$858.59
|
|
|
CORRECT METACARPAL FLAW
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
CPT 26565
|
| Hospital Charge Code |
6126565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$801.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$1,068.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
CORRECT METACARPAL FLAW
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
CPT 26565
|
| Hospital Charge Code |
6126565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$1,269.20 |
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
CORRECT RECTAL PROLAPSE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 45541
|
| Hospital Charge Code |
6145541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.45 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,670.25
|
| Rate for Payer: First Health Commercial |
$1,768.50
|
| Rate for Payer: First Health Workers Compensation |
$758.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,768.50
|
| Rate for Payer: GEHA Commercial |
$1,375.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,768.50
|
| Rate for Payer: Multiplan All |
$1,788.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,375.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,768.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,866.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,473.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,827.45
|
| Rate for Payer: Zelis Auto |
$786.00
|
| Rate for Payer: Zelis Worker's Compensation |
$536.45
|
|
|
CORRECT RECTAL PROLAPSE
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 45540
|
| Hospital Charge Code |
6145540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.15 |
| Max. Negotiated Rate |
$2,102.35 |
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$1,881.05
|
| Rate for Payer: First Health Commercial |
$1,991.70
|
| Rate for Payer: First Health Workers Compensation |
$854.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,991.70
|
| Rate for Payer: GEHA Commercial |
$1,549.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,991.70
|
| Rate for Payer: Multiplan All |
$2,013.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,991.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,102.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,659.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,058.09
|
| Rate for Payer: Zelis Auto |
$885.20
|
| Rate for Payer: Zelis Worker's Compensation |
$604.15
|
|
|
CORRECT RECTAL PROLAPSE
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 45541
|
| Hospital Charge Code |
6145541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.45 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,179.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,670.25
|
| Rate for Payer: First Health Commercial |
$1,768.50
|
| Rate for Payer: First Health Workers Compensation |
$758.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,768.50
|
| Rate for Payer: GEHA Commercial |
$1,572.00
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,768.50
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,788.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,375.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,768.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,866.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,827.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$786.00
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$536.45
|
|
|
CORRECT RECTAL PROLAPSE
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 45540
|
| Hospital Charge Code |
6145540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$553.25 |
| Max. Negotiated Rate |
$2,102.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$1,881.05
|
| Rate for Payer: First Health Commercial |
$1,991.70
|
| Rate for Payer: First Health Workers Compensation |
$854.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,991.70
|
| Rate for Payer: GEHA Commercial |
$1,770.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,991.70
|
| Rate for Payer: Humana ChoiceCare |
$575.38
|
| Rate for Payer: Multiplan All |
$2,013.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,327.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,991.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,102.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,659.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,947.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$553.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,058.09
|
| Rate for Payer: Zelis Auto |
$885.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,106.50
|
| Rate for Payer: Zelis Worker's Compensation |
$604.15
|
|
|
CORR HALUX RIGDUS W/IMPLT
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
6191071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.59 |
| Max. Negotiated Rate |
$1,418.35 |
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cigna Commercial |
$1,269.05
|
| Rate for Payer: First Health Commercial |
$1,343.70
|
| Rate for Payer: First Health Workers Compensation |
$576.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,343.70
|
| Rate for Payer: GEHA Commercial |
$1,045.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,343.70
|
| Rate for Payer: Multiplan All |
$1,358.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,045.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,343.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,418.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,119.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,388.49
|
| Rate for Payer: Zelis Auto |
$597.20
|
| Rate for Payer: Zelis Worker's Compensation |
$407.59
|
|
|
CORR HALUX RIGDUS W/IMPLT
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
6191071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.59 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,655.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,655.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,896.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cigna Commercial |
$1,269.05
|
| Rate for Payer: First Health Commercial |
$1,343.70
|
| Rate for Payer: First Health Workers Compensation |
$576.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,343.70
|
| Rate for Payer: GEHA Commercial |
$1,194.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,343.70
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,955.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,358.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,045.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,343.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,412.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,955.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,418.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,119.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,955.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,388.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$597.20
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$407.59
|
|
|
corticosteroid binding glob REF500130
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 84449
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.40
|
| 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 |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.00
|
| 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 |
$28.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$18.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$19.80
|
| Rate for Payer: Humana Medicare Advantage |
$18.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.00
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| 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 |
$30.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.00
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.64
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.00
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$15.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.27
|
|
|
corticosteroid binding glob REF500130
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 84449
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.27 |
| 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 |
$28.67
|
| 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 |
$20.27
|
|
|
CORTICOSTEROID BINDING GLOBULIN CBG REF
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 84449
|
| Hospital Charge Code |
2300054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.27 |
| 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 |
$28.67
|
| 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 |
$20.27
|
|
|
CORTICOSTEROID BINDING GLOBULIN CBG REF
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 84449
|
| Hospital Charge Code |
2300054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.40
|
| 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 |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.00
|
| 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 |
$28.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$18.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$19.80
|
| Rate for Payer: Humana Medicare Advantage |
$18.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.00
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| 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 |
$30.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.00
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.64
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.00
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$15.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.27
|
|
|
cortisol, am REF104018
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
cortisol, am REF104018
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.30
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$16.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.30
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.71
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.97
|
| Rate for Payer: United Healthcare Commercial |
$227.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.30
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$13.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.56
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
cortisol free 24hr urine REF004432
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
22990760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$238.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
cortisol free 24hr urine REF004432
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
22990760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.71
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$272.80
|
| Rate for Payer: GEHA Medicare |
$16.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Humana ChoiceCare |
$18.38
|
| Rate for Payer: Humana Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.71
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.41
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.42
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$289.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.71
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Medicare |
$14.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.05
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
cortisol, pm REF104026
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200791
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
cortisol, pm REF104026
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200791
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.30
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$16.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.30
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.71
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.97
|
| Rate for Payer: United Healthcare Commercial |
$227.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.30
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$13.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.56
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
cortisol REF004051
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200795
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.30
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$16.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.30
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.71
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.97
|
| Rate for Payer: United Healthcare Commercial |
$227.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.30
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$13.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.56
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
cortisol REF004051
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2200795
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
CORTISOL SALIVA
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
2300007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$238.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
CORTISOL SALIVA
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
2300007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.71
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$272.80
|
| Rate for Payer: GEHA Medicare |
$16.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Humana ChoiceCare |
$18.38
|
| Rate for Payer: Humana Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.71
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.41
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.42
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$289.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.71
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Medicare |
$14.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.05
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
