|
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
|
|
|
hcv w/reflex to quant REF144050
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
2200845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$21.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.52
|
|
|
hcv w/reflex to quant REF144050
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
2200845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.27
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$21.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: GEHA Medicare |
$14.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$15.70
|
| Rate for Payer: Humana Medicare Advantage |
$14.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.27
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.26
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.54
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.98
|
| Rate for Payer: United Healthcare Commercial |
$86.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.27
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Medicare |
$12.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.12
|
| Rate for Payer: Zelis Worker's Compensation |
$15.52
|
|
|
HEADLESS TROCAR DRILL PIN 75MM
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$498.75 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,695.75
|
| Rate for Payer: First Health Commercial |
$1,795.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,795.50
|
| Rate for Payer: GEHA Commercial |
$1,596.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,795.50
|
| Rate for Payer: Humana ChoiceCare |
$518.70
|
| Rate for Payer: Multiplan All |
$1,815.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,197.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,396.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,795.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,895.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,496.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,755.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,855.35
|
| Rate for Payer: Zelis Auto |
$798.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$997.50
|
|
|
HEADLESS TROCAR DRILL PIN 75MM
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,695.75
|
| Rate for Payer: First Health Commercial |
$1,795.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,795.50
|
| Rate for Payer: GEHA Commercial |
$1,396.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,795.50
|
| Rate for Payer: Multiplan All |
$1,815.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,396.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,795.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,895.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,496.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,855.35
|
| Rate for Payer: Zelis Auto |
$798.00
|
|
|
HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
8596156
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
8596156
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 96170
|
| Hospital Charge Code |
9396170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$392.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Humana ChoiceCare |
$127.40
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$294.00
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$431.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$245.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 96170
|
| Hospital Charge Code |
9396170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$343.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 M
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
8596158
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 M
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
8596158
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
HEEL CUP
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
8230080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$92.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$92.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.21
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.70
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
HEEL CUP
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
8800022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
HEEL CUP
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
8800022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$92.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$92.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.21
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.70
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
HEEL CUP
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
8230080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
HEEL LIFT
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
8800023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.80 |
| 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: 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
|
|
|
HEEL LIFT
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
8800023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$134.01
|
| 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 |
$134.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$106.16
|
| Rate for Payer: Cash Price |
$88.20
|
| 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: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$38.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$108.32
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$88.20
|
| 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 |
$125.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$108.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$129.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.50
|
|
|
HEEL LIFT
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
8230081
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$134.01
|
| 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 |
$134.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$106.16
|
| Rate for Payer: Cash Price |
$88.20
|
| 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: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$38.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$108.32
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$88.20
|
| 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 |
$125.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$108.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$129.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.50
|
|
|
HEEL LIFT
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L3332
|
| Hospital Charge Code |
8230081
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.80 |
| 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: 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
|
|
|
Helicobacter pylori Urea Breath Test
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
2299355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$134.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$121.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$121.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.36
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$107.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$76.00
|
| Rate for Payer: GEHA Medicare |
$67.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Humana Medicare Advantage |
$67.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$98.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.36
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.51
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$113.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$98.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$134.72
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.01
|
| Rate for Payer: United Healthcare Commercial |
$80.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.36
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Medicare |
$57.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.83
|
| Rate for Payer: Zelis Worker's Compensation |
$75.81
|
|
|
Helicobacter pylori Urea Breath Test
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
2299355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$107.22 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$107.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$66.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.81
|
|
|
helper t-lymph marker CD4 REF505008
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
2300306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.21
|
| 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 |
$48.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$26.78
|
| 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 |
$51.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$26.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$29.46
|
| Rate for Payer: Humana Medicare Advantage |
$26.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$44.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$38.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$26.78
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.53
|
| 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 |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$38.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$26.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$53.56
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.24
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$26.78
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$22.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.14
|
| Rate for Payer: Zelis Worker's Compensation |
$36.48
|
|
|
helper t-lymph marker CD4 REF505008
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
2300306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.48 |
| 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 |
$51.60
|
| 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 |
$36.48
|
|
|
HEMAGLOBINOPATHY EVALUATION
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
22990738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$33.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.76
|
|
|
HEMAGLOBINOPATHY EVALUATION
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
22990738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$33.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$23.76
|
|
