|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
7917340
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
7917340
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
6117340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
8300067
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
6117340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
8300067
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
CRYPTOCOCCUS AB IFA CSF
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
2200064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$14.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$15.85
|
| Rate for Payer: Humana Medicare Advantage |
$14.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.41
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.50
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.82
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.41
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$12.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.29
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
CRYPTOCOCCUS AB IFA CSF
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
2200064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
CRYPTOCOCCUS AB IFA CSF
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
2300013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$14.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$15.85
|
| Rate for Payer: Humana Medicare Advantage |
$14.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.41
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.50
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.82
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.41
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$12.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.29
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
CRYPTOCOCCUS AB IFA CSF
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
2300013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
cryptococcus ag, csf REF183016
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
2200440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
cryptococcus ag, csf REF183016
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
2200440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
cryptococcus ag serum REF183025
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
2200749
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
cryptococcus ag serum REF183025
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
2200749
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
cryptosporidium, EIA REF183020
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
2200423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.82
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$20.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$143.20
|
| Rate for Payer: GEHA Medicare |
$13.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Humana ChoiceCare |
$15.20
|
| Rate for Payer: Humana Medicare Advantage |
$13.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.82
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.49
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.64
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.54
|
| Rate for Payer: United Healthcare Commercial |
$152.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.82
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Medicare |
$11.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.58
|
| Rate for Payer: Zelis Worker's Compensation |
$14.73
|
|
|
cryptosporidium, EIA REF183020
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
2200423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$20.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$125.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.73
|
|
|
crystals synovial fluid REF005355
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
22990906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$28.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.82
|
|
|
crystals synovial fluid REF005355
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
22990906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$28.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: GEHA Medicare |
$7.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Humana Medicare Advantage |
$7.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.33
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.46
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14.66
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.18
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.33
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Medicare |
$6.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.82
|
|
|
csf culture fungus REF008482
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
2299268
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$14.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.26
|
|
|
csf culture fungus REF008482
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
2299268
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.71
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$14.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: GEHA Medicare |
$7.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$8.48
|
| Rate for Payer: Humana Medicare Advantage |
$7.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.71
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.11
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.42
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.56
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.71
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$6.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.25
|
| Rate for Payer: Zelis Worker's Compensation |
$10.26
|
|
|
CSF GLUCOSE (Vitros)
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
2232238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$7.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.98
|
|
|
CSF GLUCOSE (Vitros)
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
2232238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$7.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$4.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.93
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$4.98
|
|
|
csf immunoglobulin G, quant REF012211
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2299811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$15.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$9.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$10.23
|
| Rate for Payer: Humana Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.30
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.81
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.60
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.11
|
| Rate for Payer: United Healthcare Commercial |
$263.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$7.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.16
|
| Rate for Payer: Zelis Worker's Compensation |
$10.84
|
|
|
csf immunoglobulin G, quant REF012211
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2299811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$15.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.84
|
|
|
CSF PROTEIN (Vitros)
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
2232237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$7.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.57
|
|
