|
HAND TENDON RECONSTRUCTION
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
CPT 26502
|
| Hospital Charge Code |
6126502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.83 |
| Max. Negotiated Rate |
$1,304.35 |
| Rate for Payer: Cash Price |
$823.80
|
| Rate for Payer: Cigna Commercial |
$1,167.05
|
| Rate for Payer: First Health Commercial |
$1,235.70
|
| Rate for Payer: First Health Workers Compensation |
$530.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,235.70
|
| Rate for Payer: GEHA Commercial |
$961.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,235.70
|
| Rate for Payer: Multiplan All |
$1,249.43
|
| Rate for Payer: OMNI Networks Commercial |
$961.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,235.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,304.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.89
|
| Rate for Payer: Zelis Auto |
$549.20
|
| Rate for Payer: Zelis Worker's Compensation |
$374.83
|
|
|
HAND TENDON RECONSTRUCTION
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
6126500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.70 |
| Max. Negotiated Rate |
$1,164.70 |
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: First Health Workers Compensation |
$473.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$858.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: Zelis Auto |
$490.40
|
| Rate for Payer: Zelis Worker's Compensation |
$334.70
|
|
|
hantavirus ab igm popREF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$122.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
hantavirus ab igm popREF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$140.00
|
| Rate for Payer: GEHA Medicare |
$12.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Humana ChoiceCare |
$14.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.88
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.90
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.76
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$148.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.88
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Medicare |
$10.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.46
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
hantavirus antibodies elisa REF835027
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$140.00
|
| Rate for Payer: GEHA Medicare |
$12.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Humana ChoiceCare |
$14.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.88
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.90
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.76
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$148.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.88
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Medicare |
$10.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.46
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
hantavirus antibodies elisa REF835027
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$122.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
HAPTOGLOBIN QUANT REF
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
2300057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.53 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$51.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$172.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Worker's Compensation |
$36.53
|
|
|
HAPTOGLOBIN QUANT REF
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
2300057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$53.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$53.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.53
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$51.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$197.60
|
| Rate for Payer: GEHA Medicare |
$29.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Humana ChoiceCare |
$32.48
|
| Rate for Payer: Humana Medicare Advantage |
$29.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.53
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.20
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59.06
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.94
|
| Rate for Payer: United Healthcare Commercial |
$209.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.53
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Medicare |
$25.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.44
|
| Rate for Payer: Zelis Worker's Compensation |
$36.53
|
|
|
haptoglobin quant REF001628
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
2200100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$22.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$197.60
|
| Rate for Payer: GEHA Medicare |
$12.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Humana ChoiceCare |
$13.84
|
| Rate for Payer: Humana Medicare Advantage |
$12.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.58
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.39
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.16
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.33
|
| Rate for Payer: United Healthcare Commercial |
$209.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.58
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Medicare |
$10.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.10
|
| Rate for Payer: Zelis Worker's Compensation |
$15.61
|
|
|
haptoglobin quant REF001628
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
2200100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$22.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$172.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.61
|
|
|
HARVEST CULTURED SKIN GRAFT
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 15040
|
| Hospital Charge Code |
6115040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$338.30
|
| Rate for Payer: First Health Commercial |
$358.20
|
| Rate for Payer: First Health Workers Compensation |
$153.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$358.20
|
| Rate for Payer: GEHA Commercial |
$318.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$358.20
|
| 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 |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$362.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$278.60
|
| Rate for Payer: One Health Plan PPO/POS |
$358.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$378.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$298.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$370.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$159.20
|
| 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 |
$108.65
|
|
|
HARVEST CULTURED SKIN GRAFT
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 15040
|
| Hospital Charge Code |
6115040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$338.30
|
| Rate for Payer: First Health Commercial |
$358.20
|
| Rate for Payer: First Health Workers Compensation |
$153.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$358.20
|
| Rate for Payer: GEHA Commercial |
$278.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$358.20
|
| Rate for Payer: Multiplan All |
$362.18
|
| Rate for Payer: OMNI Networks Commercial |
$278.60
|
| Rate for Payer: One Health Plan PPO/POS |
$358.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$378.10
|
| Rate for Payer: Three Rivers Provider Network All |
$298.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$370.14
|
| Rate for Payer: Zelis Auto |
$159.20
|
| Rate for Payer: Zelis Worker's Compensation |
$108.65
|
|
|
hazelnut tree, IgE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
hazelnut tree, IgE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
HBOT FULL BODY CHAMBER 30M
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 99183
|
| Hospital Charge Code |
20300099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Humana ChoiceCare |
$89.18
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$205.80
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$301.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$171.50
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
HBOT FULL BODY CHAMBER 30M
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
1999183
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$277.91 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Cash Price |
$610.80
|
| Rate for Payer: Cigna Commercial |
$865.30
|
| Rate for Payer: First Health Commercial |
$916.20
|
| Rate for Payer: First Health Workers Compensation |
$393.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$916.20
|
| Rate for Payer: GEHA Commercial |
$712.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$916.20
|
| Rate for Payer: Multiplan All |
$926.38
|
| Rate for Payer: OMNI Networks Commercial |
$712.60
|
| Rate for Payer: One Health Plan PPO/POS |
$916.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$763.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$946.74
|
| Rate for Payer: Zelis Auto |
$407.20
|
| Rate for Payer: Zelis Worker's Compensation |
$277.91
|
|
|
HBOT FULL BODY CHAMBER 30M
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 99183
|
| Hospital Charge Code |
20300099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$240.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
HBOT FULL BODY CHAMBER 30M
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
1999183
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$163.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$163.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$129.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$130.94
|
| Rate for Payer: Cash Price |
$610.80
|
| Rate for Payer: Cash Price |
$610.80
|
| Rate for Payer: Cigna Commercial |
$865.30
|
| Rate for Payer: First Health Commercial |
$916.20
|
| Rate for Payer: First Health Workers Compensation |
$393.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$916.20
|
| Rate for Payer: GEHA Commercial |
$814.40
|
| Rate for Payer: GEHA Medicare |
$130.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$916.20
|
| Rate for Payer: Humana ChoiceCare |
$144.03
|
| Rate for Payer: Humana Medicare Advantage |
$130.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$219.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$132.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$130.94
|
| Rate for Payer: Multiplan All |
$926.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.60
|
| Rate for Payer: OMNI Networks Commercial |
$712.60
|
| Rate for Payer: One Health Plan PPO/POS |
$916.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$152.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$132.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$130.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$967.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$261.88
|
| Rate for Payer: Three Rivers Provider Network All |
$763.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$128.32
|
| Rate for Payer: United Healthcare Commercial |
$865.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$946.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$130.94
|
| Rate for Payer: Zelis Auto |
$407.20
|
| Rate for Payer: Zelis Medicare |
$111.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.13
|
| Rate for Payer: Zelis Worker's Compensation |
$277.91
|
|
|
HCG BETA QUANT (Vitros)
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2232234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$27.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: GEHA Medicare |
$15.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$16.55
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.05
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.59
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.10
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.75
|
| Rate for Payer: United Healthcare Commercial |
$267.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.05
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Medicare |
$12.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.06
|
| Rate for Payer: Zelis Worker's Compensation |
$19.60
|
|
|
HCG BETA QUANT (Vitros)
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2232234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$27.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.60
|
|
|
HCG QUAL SERUM
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
2206038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$19.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$7.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$8.27
|
| Rate for Payer: Humana Medicare Advantage |
$7.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.52
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.78
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.63
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.04
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.37
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.52
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$6.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.02
|
| Rate for Payer: Zelis Worker's Compensation |
$13.62
|
|
|
HCG QUAL SERUM
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
2206038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$19.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.62
|
|
|
HCG QUAL URINE
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
2206039
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| 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 |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| 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 |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| 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 |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
HCG QUAL URINE
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
2206039
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.79 |
| 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 |
$9.60
|
| 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 |
$6.79
|
|
|
hcv rna qnt pcr reflex ns5b REF550349
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2200414
|
|
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 |
$67.87
|
| 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 |
$47.99
|
|
