|
EARDRUM REVISION
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 69450
|
| Hospital Charge Code |
6169450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$935.00
|
| Rate for Payer: First Health Commercial |
$990.00
|
| Rate for Payer: First Health Workers Compensation |
$424.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.00
|
| Rate for Payer: GEHA Commercial |
$770.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.00
|
| Rate for Payer: Multiplan All |
$1,001.00
|
| Rate for Payer: OMNI Networks Commercial |
$770.00
|
| Rate for Payer: One Health Plan PPO/POS |
$990.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.00
|
| Rate for Payer: Three Rivers Provider Network All |
$825.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.00
|
| Rate for Payer: Zelis Auto |
$440.00
|
| Rate for Payer: Zelis Worker's Compensation |
$300.30
|
|
|
EARDRUM REVISION
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 69450
|
| Hospital Charge Code |
6169450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$935.00
|
| Rate for Payer: First Health Commercial |
$990.00
|
| Rate for Payer: First Health Workers Compensation |
$424.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.00
|
| Rate for Payer: GEHA Commercial |
$880.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.00
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,001.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$770.00
|
| Rate for Payer: One Health Plan PPO/POS |
$990.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$825.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$440.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$300.30
|
|
|
ebv abs to early ag, IgG REF096248
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
2200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$21.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$13.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$14.43
|
| Rate for Payer: Humana Medicare Advantage |
$13.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.12
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.30
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.24
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.86
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.12
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$11.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.74
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
ebv abs to early ag, IgG REF096248
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
2200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$21.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
ebv abs to vca, IgG REF096230
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
22990366
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$27.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$161.60
|
| Rate for Payer: GEHA Medicare |
$18.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Humana ChoiceCare |
$19.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.14
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.84
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.28
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.78
|
| Rate for Payer: United Healthcare Commercial |
$171.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.14
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Medicare |
$15.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.77
|
| Rate for Payer: Zelis Worker's Compensation |
$19.49
|
|
|
ebv abs to vca, IgG REF096230
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
22990366
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$27.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$141.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.49
|
|
|
ebv abs to vca, IgM REF096735
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
22990367
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$27.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$161.60
|
| Rate for Payer: GEHA Medicare |
$18.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Humana ChoiceCare |
$19.95
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.14
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.84
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.28
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.78
|
| Rate for Payer: United Healthcare Commercial |
$171.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.14
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Medicare |
$15.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.77
|
| Rate for Payer: Zelis Worker's Compensation |
$19.49
|
|
|
ebv abs to vca, IgM REF096735
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
22990367
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$27.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$141.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.49
|
|
|
ebv nuclear ag ab, IgG REF010272
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2200460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$23.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.74
|
|
|
ebv nuclear ag ab, IgG REF010272
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2200460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$23.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: GEHA Medicare |
$15.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$16.82
|
| Rate for Payer: Humana Medicare Advantage |
$15.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.29
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.99
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.58
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.98
|
| Rate for Payer: United Healthcare Commercial |
$124.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.29
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Medicare |
$13.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.35
|
| Rate for Payer: Zelis Worker's Compensation |
$16.74
|
|
|
ebv, qual, pcr REF138289
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22990790
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| 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 |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| 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 |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| 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 |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$284.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
ebv, qual, pcr REF138289
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22990790
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| 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 |
$55.45
|
| 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 |
$39.21
|
|
|
ebv, quant, pcr REF138230
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2200316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$47.12
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$71.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.84
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
ebv, quant, pcr REF138230
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2200316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
ECG RECORDING
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
8600009
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
ECG RECORDING
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
8600009
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
ECG RECORD/REVIEW
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
8600008
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
ECG RECORD/REVIEW
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
8600008
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Humana ChoiceCare |
$144.30
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$333.00
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$488.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.50
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
ECG/REVIEW, INTERPRET ONL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
9000005
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$51.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
ECG/REVIEW, INTERPRET ONL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
9000005
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$58.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Humana ChoiceCare |
$18.98
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.80
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$64.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$36.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
echinococcus ab EIA REF138768
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
2299725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.41
|
| 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 |
$23.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.01
|
| 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 |
$21.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$13.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$14.31
|
| Rate for Payer: Humana Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.01
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.12
|
| 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 |
$21.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.02
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.75
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.01
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$11.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.61
|
| Rate for Payer: Zelis Worker's Compensation |
$15.32
|
|
|
echinococcus ab EIA REF138768
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
2299725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.32 |
| 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 |
$21.66
|
| 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 |
$15.32
|
|
|
ECHO EXAMINATION PROCEDUR
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
8900024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
ECHO EXAMINATION PROCEDUR
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
8900024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$167.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$75.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8204015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.80
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.64
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
