|
CULT EPIDERM GRFT F/N/HFG +%
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 15157
|
| Hospital Charge Code |
6115157
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$479.75 |
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: First Health Commercial |
$454.50
|
| Rate for Payer: First Health Workers Compensation |
$194.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$454.50
|
| Rate for Payer: GEHA Commercial |
$353.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$454.50
|
| Rate for Payer: Multiplan All |
$459.55
|
| Rate for Payer: OMNI Networks Commercial |
$353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.75
|
| Rate for Payer: Three Rivers Provider Network All |
$378.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.65
|
| Rate for Payer: Zelis Auto |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.87
|
|
|
CULT SKIN GRAFT F/N/HF/G
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
CPT 15155
|
| Hospital Charge Code |
6115155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$816.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$1,156.85
|
| Rate for Payer: First Health Commercial |
$1,224.90
|
| Rate for Payer: First Health Workers Compensation |
$525.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.90
|
| Rate for Payer: GEHA Commercial |
$1,088.80
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.90
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,238.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$952.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,265.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$544.40
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$371.55
|
|
|
CULT SKIN GRAFT F/N/HF/G
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
CPT 15155
|
| Hospital Charge Code |
6115155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.55 |
| Max. Negotiated Rate |
$1,292.95 |
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$1,156.85
|
| Rate for Payer: First Health Commercial |
$1,224.90
|
| Rate for Payer: First Health Workers Compensation |
$525.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.90
|
| Rate for Payer: GEHA Commercial |
$952.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.90
|
| Rate for Payer: Multiplan All |
$1,238.51
|
| Rate for Payer: OMNI Networks Commercial |
$952.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,265.73
|
| Rate for Payer: Zelis Auto |
$544.40
|
| Rate for Payer: Zelis Worker's Compensation |
$371.55
|
|
|
CULT SKIN GRAFT T/A/L +%
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 15152
|
| Hospital Charge Code |
6115152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.18 |
| Max. Negotiated Rate |
$448.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$265.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$376.55
|
| Rate for Payer: First Health Commercial |
$398.70
|
| Rate for Payer: First Health Workers Compensation |
$171.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$398.70
|
| Rate for Payer: GEHA Commercial |
$354.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$398.70
|
| Rate for Payer: Humana ChoiceCare |
$115.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$403.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$265.80
|
| Rate for Payer: OMNI Networks Commercial |
$310.10
|
| Rate for Payer: One Health Plan PPO/POS |
$398.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$420.85
|
| Rate for Payer: Three Rivers Provider Network All |
$332.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$389.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.99
|
| Rate for Payer: Zelis Auto |
$177.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.50
|
| Rate for Payer: Zelis Worker's Compensation |
$120.94
|
|
|
CULT SKIN GRAFT T/A/L +%
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 15152
|
| Hospital Charge Code |
6115152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$376.55
|
| Rate for Payer: First Health Commercial |
$398.70
|
| Rate for Payer: First Health Workers Compensation |
$171.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$398.70
|
| Rate for Payer: GEHA Commercial |
$310.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$398.70
|
| Rate for Payer: Multiplan All |
$403.13
|
| Rate for Payer: OMNI Networks Commercial |
$310.10
|
| Rate for Payer: One Health Plan PPO/POS |
$398.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$420.85
|
| Rate for Payer: Three Rivers Provider Network All |
$332.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.99
|
| Rate for Payer: Zelis Auto |
$177.20
|
| Rate for Payer: Zelis Worker's Compensation |
$120.94
|
|
|
CULT SKIN GRFT F/N/HFG ADD
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 15156
|
| Hospital Charge Code |
6115156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.86 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: First Health Workers Compensation |
$182.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Worker's Compensation |
$128.86
|
|
|
CULT SKIN GRFT F/N/HFG ADD
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 15156
|
| Hospital Charge Code |
6115156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$448.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: First Health Workers Compensation |
$182.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
| Rate for Payer: Zelis Worker's Compensation |
$128.86
|
|
|
CULT SKIN GRFT T/A/L ADDL
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 15151
|
| Hospital Charge Code |
6115151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.19 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna Commercial |
$302.60
|
| Rate for Payer: First Health Commercial |
$320.40
|
| Rate for Payer: First Health Workers Compensation |
$137.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$320.40
|
| Rate for Payer: GEHA Commercial |
$249.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$320.40
|
| Rate for Payer: Multiplan All |
$323.96
|
| Rate for Payer: OMNI Networks Commercial |
$249.20
|
| Rate for Payer: One Health Plan PPO/POS |
$320.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$338.20
|
| Rate for Payer: Three Rivers Provider Network All |
$267.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$331.08
|
| Rate for Payer: Zelis Auto |
$142.40
|
| Rate for Payer: Zelis Worker's Compensation |
$97.19
|
|
|
CULT SKIN GRFT T/A/L ADDL
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 15151
|
| Hospital Charge Code |
6115151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$448.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna Commercial |
$302.60
|
| Rate for Payer: First Health Commercial |
$320.40
|
| Rate for Payer: First Health Workers Compensation |
$137.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$320.40
|
| Rate for Payer: GEHA Commercial |
$284.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$320.40
|
| Rate for Payer: Humana ChoiceCare |
$92.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$323.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$213.60
|
| Rate for Payer: OMNI Networks Commercial |
$249.20
|
| Rate for Payer: One Health Plan PPO/POS |
$320.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$338.20
|
| Rate for Payer: Three Rivers Provider Network All |
$267.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$313.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$331.08
|
| Rate for Payer: Zelis Auto |
$142.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.00
|
| Rate for Payer: Zelis Worker's Compensation |
$97.19
|
|
|
CULT SKIN GRFT T/ARM/LEG
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 15150
|
| Hospital Charge Code |
6115150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.27 |
| Max. Negotiated Rate |
$1,250.20 |
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$1,118.60
|
| Rate for Payer: First Health Commercial |
$1,184.40
|
| Rate for Payer: First Health Workers Compensation |
$508.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,184.40
|
| Rate for Payer: GEHA Commercial |
$921.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,184.40
|
| Rate for Payer: Multiplan All |
$1,197.56
|
| Rate for Payer: OMNI Networks Commercial |
$921.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,184.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,250.20
|
| Rate for Payer: Three Rivers Provider Network All |
$987.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,223.88
|
| Rate for Payer: Zelis Auto |
$526.40
|
| Rate for Payer: Zelis Worker's Compensation |
$359.27
|
|
|
CULT SKIN GRFT T/ARM/LEG
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 15150
|
| Hospital Charge Code |
6115150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$789.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$1,118.60
|
| Rate for Payer: First Health Commercial |
$1,184.40
|
| Rate for Payer: First Health Workers Compensation |
$508.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,184.40
|
| Rate for Payer: GEHA Commercial |
$1,052.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,184.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,197.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$921.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,184.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,250.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$987.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,223.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$526.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$359.27
|
|
|
culture anaerobic extended inc REF008900
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
2200330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.47
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$16.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$9.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$10.42
|
| Rate for Payer: Humana Medicare Advantage |
$9.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.47
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.10
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.94
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$284.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.47
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$8.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.36
|
| Rate for Payer: Zelis Worker's Compensation |
$11.59
|
|
|
culture anaerobic extended inc REF008900
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
2200330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$16.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.59
|
|
|
culture anaerobic REF008904
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
2207075
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$16.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.59
|
|
|
culture anaerobic REF008904
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
2207075
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.47
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$16.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$9.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$10.42
|
| Rate for Payer: Humana Medicare Advantage |
$9.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.47
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.10
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.94
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$284.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.47
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$8.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.36
|
| Rate for Payer: Zelis Worker's Compensation |
$11.59
|
|
|
CULTURE BLD set 3
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 3
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 4
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 4
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 5
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207047
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 5
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207047
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 6
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207048
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLD set 6
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207048
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLOOD
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CULTURE BLOOD
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
