|
COVID19 ARIES RT-PCR AGH
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2202021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
covid19 emp 24hr roswell REF
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2202020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$51.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$56.44
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.31
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.23
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.62
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.28
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.31
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$43.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.57
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
covid19 emp 24hr roswell REF
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2202020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
COVID-19, Flu A/B, RSV RT-PCR Cepheid
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
2200776
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$177.43
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$158.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$181.04
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$365.40
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$209.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$181.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$535.92
|
| Rate for Payer: United Healthcare Commercial |
$517.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$181.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$304.50
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
COVID-19, Flu A/B, RSV RT-PCR Cepheid
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
2200776
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
covid19 result 48hr ip/emp LC REF990011
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2200638
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$51.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$56.44
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.31
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.23
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.62
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.28
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.31
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$43.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.57
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
covid19 result 48hr ip/emp LC REF990011
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2200638
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
COVID-19, RT-PCR Cepheid AGH
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2200775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$51.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$56.44
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.31
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.23
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.62
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.28
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.31
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$43.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.57
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
COVID-19, RT-PCR Cepheid AGH
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2200775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
COVID19 STAT 15 MIN RESULT ABBOTT AGH
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2200020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
COVID19 STAT 15 MIN RESULT ABBOTT AGH
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
2200020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$51.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$56.44
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.31
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.23
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.62
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.28
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.31
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$43.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.57
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
COVID-19 VACC MRNA MODERNA 0.25ML 6M-11Y
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
3303250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.89 |
| Max. Negotiated Rate |
$563.35 |
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$504.05
|
| Rate for Payer: First Health Commercial |
$533.70
|
| Rate for Payer: First Health Workers Compensation |
$228.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$533.70
|
| Rate for Payer: GEHA Commercial |
$415.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$533.70
|
| Rate for Payer: Multiplan All |
$539.63
|
| Rate for Payer: OMNI Networks Commercial |
$415.10
|
| Rate for Payer: One Health Plan PPO/POS |
$533.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$563.35
|
| Rate for Payer: Three Rivers Provider Network All |
$444.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$551.49
|
| Rate for Payer: Zelis Auto |
$237.20
|
| Rate for Payer: Zelis Worker's Compensation |
$161.89
|
|
|
COVID-19 VACC MRNA MODERNA 0.25ML 6M-11Y
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
3303250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.18 |
| Max. Negotiated Rate |
$563.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$220.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$355.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$220.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$174.75
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$504.05
|
| Rate for Payer: First Health Commercial |
$533.70
|
| Rate for Payer: First Health Workers Compensation |
$228.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$533.70
|
| Rate for Payer: GEHA Commercial |
$161.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$533.70
|
| Rate for Payer: Humana ChoiceCare |
$154.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$178.31
|
| Rate for Payer: Multiplan All |
$539.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$355.80
|
| Rate for Payer: OMNI Networks Commercial |
$415.10
|
| Rate for Payer: One Health Plan PPO/POS |
$533.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$205.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$178.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$563.35
|
| Rate for Payer: Three Rivers Provider Network All |
$444.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$521.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$178.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$551.49
|
| Rate for Payer: Zelis Auto |
$237.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$296.50
|
| Rate for Payer: Zelis Worker's Compensation |
$161.89
|
|
|
COVID-19 VACC MRNA MODERNA 0.5ML 12YRS+
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
3303249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$242.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$383.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$242.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.09
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$543.15
|
| Rate for Payer: First Health Commercial |
$575.10
|
| Rate for Payer: First Health Workers Compensation |
$246.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$575.10
|
| Rate for Payer: GEHA Commercial |
$177.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$575.10
|
| Rate for Payer: Humana ChoiceCare |
$166.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.00
|
| Rate for Payer: Multiplan All |
$581.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$383.40
|
| Rate for Payer: OMNI Networks Commercial |
$447.30
|
| Rate for Payer: One Health Plan PPO/POS |
$575.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$607.05
|
| Rate for Payer: Three Rivers Provider Network All |
$479.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$562.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$594.27
|
| Rate for Payer: Zelis Auto |
$255.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$319.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.45
|
|
|
COVID-19 VACC MRNA MODERNA 0.5ML 12YRS+
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
3303249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$543.15
|
| Rate for Payer: First Health Commercial |
$575.10
|
| Rate for Payer: First Health Workers Compensation |
$246.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$575.10
|
| Rate for Payer: GEHA Commercial |
$447.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$575.10
|
| Rate for Payer: Multiplan All |
$581.49
|
| Rate for Payer: OMNI Networks Commercial |
$447.30
|
| Rate for Payer: One Health Plan PPO/POS |
$575.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$607.05
|
| Rate for Payer: Three Rivers Provider Network All |
$479.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$594.27
|
| Rate for Payer: Zelis Auto |
$255.60
|
| Rate for Payer: Zelis Worker's Compensation |
$174.45
|
|
|
COVID & INFLU A&B ANTIGEN 16 MIN AGH
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 87428
|
| Hospital Charge Code |
2202030
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$83.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$70.29
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: GEHA Medicare |
$70.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Humana ChoiceCare |
$77.32
|
| Rate for Payer: Humana Medicare Advantage |
$70.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$118.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$70.29
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.49
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$98.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$85.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$70.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$140.58
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$68.88
|
| Rate for Payer: United Healthcare Commercial |
$279.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$70.29
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Medicare |
$59.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.35
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
COVID & INFLU A&B ANTIGEN 16 MIN AGH
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 87428
|
| Hospital Charge Code |
2202030
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
CPAP BIPAP INITIAL
|
Facility
|
OP
|
$1,212.35
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4008999
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$1,151.73 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$727.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$193.13
|
| Rate for Payer: Cash Price |
$727.41
|
| Rate for Payer: Cash Price |
$727.41
|
| Rate for Payer: Cigna Commercial |
$1,030.50
|
| Rate for Payer: First Health Commercial |
$1,091.12
|
| Rate for Payer: First Health Workers Compensation |
$468.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,091.12
|
| Rate for Payer: GEHA Commercial |
$969.88
|
| Rate for Payer: GEHA Medicare |
$193.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,091.12
|
| Rate for Payer: Humana ChoiceCare |
$212.44
|
| Rate for Payer: Humana Medicare Advantage |
$193.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$324.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$193.13
|
| Rate for Payer: Multiplan All |
$1,103.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.32
|
| Rate for Payer: OMNI Networks Commercial |
$848.64
|
| Rate for Payer: One Health Plan PPO/POS |
$1,091.12
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$193.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,151.73
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$386.26
|
| Rate for Payer: Three Rivers Provider Network All |
$909.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.27
|
| Rate for Payer: United Healthcare Commercial |
$1,030.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,127.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$193.13
|
| Rate for Payer: Zelis Auto |
$484.94
|
| Rate for Payer: Zelis Medicare |
$164.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.76
|
| Rate for Payer: Zelis Worker's Compensation |
$330.97
|
|
|
CPAP BIPAP INITIAL
|
Facility
|
IP
|
$1,212.35
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4008999
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$330.97 |
| Max. Negotiated Rate |
$1,151.73 |
| Rate for Payer: Cash Price |
$727.41
|
| Rate for Payer: Cigna Commercial |
$1,030.50
|
| Rate for Payer: First Health Commercial |
$1,091.12
|
| Rate for Payer: First Health Workers Compensation |
$468.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,091.12
|
| Rate for Payer: GEHA Commercial |
$848.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,091.12
|
| Rate for Payer: Multiplan All |
$1,103.24
|
| Rate for Payer: OMNI Networks Commercial |
$848.64
|
| Rate for Payer: One Health Plan PPO/POS |
$1,091.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,151.73
|
| Rate for Payer: Three Rivers Provider Network All |
$909.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,127.49
|
| Rate for Payer: Zelis Auto |
$484.94
|
| Rate for Payer: Zelis Worker's Compensation |
$330.97
|
|
|
CPAP BIPAP SUBSEQUENT
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000150
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$193.13
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$700.00
|
| Rate for Payer: GEHA Medicare |
$193.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Humana ChoiceCare |
$212.44
|
| Rate for Payer: Humana Medicare Advantage |
$193.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$324.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$193.13
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.32
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$193.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$386.26
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.27
|
| Rate for Payer: United Healthcare Commercial |
$743.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$193.13
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Medicare |
$164.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.76
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
CPAP BIPAP SUBSEQUENT
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4000150
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$612.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
CPAP FULL FACE MASK
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT A7030
|
| Hospital Charge Code |
3000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Humana ChoiceCare |
$67.86
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$156.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$130.50
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
|
CPAP FULL FACE MASK
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT A7030
|
| Hospital Charge Code |
3000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$182.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
|
CPAP VENTILATION CPAP INITIATION&MGMT
|
Facility
|
OP
|
$1,007.00
|
|
| Hospital Charge Code |
8194660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.75 |
| Max. Negotiated Rate |
$956.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$604.20
|
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: First Health Commercial |
$906.30
|
| Rate for Payer: First Health Workers Compensation |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$906.30
|
| Rate for Payer: GEHA Commercial |
$805.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$906.30
|
| Rate for Payer: Humana ChoiceCare |
$261.82
|
| Rate for Payer: Multiplan All |
$916.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$604.20
|
| Rate for Payer: OMNI Networks Commercial |
$704.90
|
| Rate for Payer: One Health Plan PPO/POS |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$956.65
|
| Rate for Payer: Three Rivers Provider Network All |
$755.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$886.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$251.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$936.51
|
| Rate for Payer: Zelis Auto |
$402.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$503.50
|
| Rate for Payer: Zelis Worker's Compensation |
$274.91
|
|
|
CPAP VENTILATION CPAP INITIATION&MGMT
|
Facility
|
IP
|
$1,007.00
|
|
| Hospital Charge Code |
8194660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.91 |
| Max. Negotiated Rate |
$956.65 |
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: First Health Commercial |
$906.30
|
| Rate for Payer: First Health Workers Compensation |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$906.30
|
| Rate for Payer: GEHA Commercial |
$704.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$906.30
|
| Rate for Payer: Multiplan All |
$916.37
|
| Rate for Payer: OMNI Networks Commercial |
$704.90
|
| Rate for Payer: One Health Plan PPO/POS |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$956.65
|
| Rate for Payer: Three Rivers Provider Network All |
$755.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$936.51
|
| Rate for Payer: Zelis Auto |
$402.80
|
| Rate for Payer: Zelis Worker's Compensation |
$274.91
|
|
