|
GENTAMICIN SULF 10 MG/ML SDV (2 ML)
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT J1580
|
| Hospital Charge Code |
3300377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$25.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
GENTAMICIN SULF 10 MG/ML SDV (2 ML)
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT J1580
|
| Hospital Charge Code |
3300377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$2.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Humana ChoiceCare |
$9.62
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.20
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
GENTAMICIN SULF 40 MG/ML SDV (2 ML)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT J1580
|
| Hospital Charge Code |
3300378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$2.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
GENTAMICIN SULF 40 MG/ML SDV (2 ML)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT J1580
|
| Hospital Charge Code |
3300378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
gentamicin trough REF007163
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
2299875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$30.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$21.43
|
|
|
gentamicin trough REF007163
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
2299875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$30.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$16.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$18.02
|
| Rate for Payer: Humana Medicare Advantage |
$16.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.38
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.85
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.76
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.05
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.38
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$13.92
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.66
|
| Rate for Payer: Zelis Worker's Compensation |
$21.43
|
|
|
GENTIAN VIOLET 1% TOPICAL SOLN, 2 OZ BOT
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00395100392
|
| Hospital Charge Code |
3301112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
GENTIAN VIOLET 1% TOPICAL SOLN, 2 OZ BOT
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00395100392
|
| Hospital Charge Code |
3301112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
G-ESOPH REFLX TST W/ELECTROD
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
6191035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$1,330.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$840.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cigna Commercial |
$1,190.85
|
| Rate for Payer: First Health Commercial |
$1,260.90
|
| Rate for Payer: First Health Workers Compensation |
$540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,260.90
|
| Rate for Payer: GEHA Commercial |
$1,120.80
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,260.90
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$1,274.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$980.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,260.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$460.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,330.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$1,050.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,302.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$560.40
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$382.47
|
|
|
G-ESOPH REFLX TST W/ELECTROD
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
6191035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$1,330.95 |
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cigna Commercial |
$1,190.85
|
| Rate for Payer: First Health Commercial |
$1,260.90
|
| Rate for Payer: First Health Workers Compensation |
$540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,260.90
|
| Rate for Payer: GEHA Commercial |
$980.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,260.90
|
| Rate for Payer: Multiplan All |
$1,274.91
|
| Rate for Payer: OMNI Networks Commercial |
$980.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,260.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,330.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,050.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,302.93
|
| Rate for Payer: Zelis Auto |
$560.40
|
| Rate for Payer: Zelis Worker's Compensation |
$382.47
|
|
|
ggt REF001958
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
2202980
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.20
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.92
|
| Rate for Payer: Humana Medicare Advantage |
$7.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.20
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.24
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14.40
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.06
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.20
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$6.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.64
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
ggt REF001958
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
2202980
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
giardia lamblia REF182204
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
2247441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$11.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$13.18
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.98
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.37
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.96
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.98
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$10.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.38
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
giardia lamblia REF182204
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
2247441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
GI COCKTAIL + Lidocaine
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300381
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.50 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.20
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$426.70
|
| Rate for Payer: First Health Commercial |
$451.80
|
| Rate for Payer: First Health Workers Compensation |
$193.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$451.80
|
| Rate for Payer: GEHA Commercial |
$401.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$130.52
|
| Rate for Payer: Multiplan All |
$456.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$301.20
|
| Rate for Payer: OMNI Networks Commercial |
$351.40
|
| Rate for Payer: One Health Plan PPO/POS |
$451.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$476.90
|
| Rate for Payer: Three Rivers Provider Network All |
$376.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$441.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$466.86
|
| Rate for Payer: Zelis Auto |
$200.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$251.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.05
|
|
|
GI COCKTAIL + Lidocaine
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300381
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.05 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$426.70
|
| Rate for Payer: First Health Commercial |
$451.80
|
| Rate for Payer: First Health Workers Compensation |
$193.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$451.80
|
| Rate for Payer: GEHA Commercial |
$351.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$451.80
|
| Rate for Payer: Multiplan All |
$456.82
|
| Rate for Payer: OMNI Networks Commercial |
$351.40
|
| Rate for Payer: One Health Plan PPO/POS |
$451.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$476.90
|
| Rate for Payer: Three Rivers Provider Network All |
$376.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$466.86
|
| Rate for Payer: Zelis Auto |
$200.80
|
| Rate for Payer: Zelis Worker's Compensation |
$137.05
|
|
|
GI WIRELESS CAPSULE PROCEDURE
|
Facility
|
OP
|
$4,114.00
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
8091112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$756.71 |
| Max. Negotiated Rate |
$3,908.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,278.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,468.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,278.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,012.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cigna Commercial |
$3,496.90
|
| Rate for Payer: First Health Commercial |
$3,702.60
|
| Rate for Payer: First Health Workers Compensation |
$1,588.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,702.60
|
| Rate for Payer: GEHA Commercial |
$3,291.20
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,702.60
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,033.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$3,743.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,879.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,702.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,192.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,033.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,908.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,085.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,033.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,826.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$1,645.60
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$1,123.12
|
|
|
GI WIRELESS CAPSULE PROCEDURE
|
Facility
|
IP
|
$4,114.00
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
8091112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,123.12 |
| Max. Negotiated Rate |
$3,908.30 |
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cigna Commercial |
$3,496.90
|
| Rate for Payer: First Health Commercial |
$3,702.60
|
| Rate for Payer: First Health Workers Compensation |
$1,588.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,702.60
|
| Rate for Payer: GEHA Commercial |
$2,879.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,702.60
|
| Rate for Payer: Multiplan All |
$3,743.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,879.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,702.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,908.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,085.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,826.02
|
| Rate for Payer: Zelis Auto |
$1,645.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,123.12
|
|
|
GLENOID MEDIUM UNIVERS
|
Facility
|
IP
|
$4,725.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$4,488.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,780.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cigna Commercial |
$4,016.25
|
| Rate for Payer: First Health Commercial |
$4,252.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,252.50
|
| Rate for Payer: GEHA Commercial |
$3,307.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,252.50
|
| Rate for Payer: Multiplan All |
$4,299.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,307.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,252.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,488.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,543.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,394.25
|
| Rate for Payer: Zelis Auto |
$1,890.00
|
|
|
GLENOID MEDIUM UNIVERS
|
Facility
|
OP
|
$4,725.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$4,488.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cigna Commercial |
$4,016.25
|
| Rate for Payer: First Health Commercial |
$4,252.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,252.50
|
| Rate for Payer: GEHA Commercial |
$3,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,252.50
|
| Rate for Payer: Humana ChoiceCare |
$1,228.50
|
| Rate for Payer: Multiplan All |
$4,299.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,835.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,307.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,252.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,488.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,543.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,158.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,181.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,394.25
|
| Rate for Payer: Zelis Auto |
$1,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,362.50
|
|
|
gliadin ab IgG REF161687
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
22990733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
gliadin ab IgG REF161687
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
22990733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$184.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
gliadin abs, IgA REF161646
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2299563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$184.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
gliadin abs, IgA REF161646
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2299563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
GLIADIN ANTIBODY IGA
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200459
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$184.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
