|
HEMATOCRIT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2299732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
HEMATOCRIT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
22990732
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
HEMATOCRIT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
22990732
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
HEMATOCRIT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2299732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
HEMATOCRIT ARTERIAL
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
4210015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$49.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
HEMATOCRIT ARTERIAL
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
4210015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$3.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$56.80
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$60.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.74
|
|
|
HEMOGLOBIN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
22990731
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$4.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.93
|
|
|
HEMOGLOBIN
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
22990731
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$4.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.93
|
|
|
HEMOGLOBIN A1C (VITROS)
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
2206440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$14.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$9.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$10.68
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.71
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.51
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.42
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$141.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.71
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$8.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.65
|
| Rate for Payer: Zelis Worker's Compensation |
$10.45
|
|
|
HEMOGLOBIN A1C (VITROS)
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
2206440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$14.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$10.45
|
|
|
HEMOGLOBIN ARTERIAL
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
4210014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$4.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$46.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2.93
|
|
|
HEMOGLOBIN ARTERIAL
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
4210014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$4.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$53.60
|
| Rate for Payer: GEHA Medicare |
$2.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Humana ChoiceCare |
$2.61
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.37
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.03
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.74
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$56.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.37
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Medicare |
$2.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.84
|
| Rate for Payer: Zelis Worker's Compensation |
$2.93
|
|
|
HEMOGLOBIN ELECTROPHORESIS REF
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2300016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$18.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$19.87
|
| Rate for Payer: Humana Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.06
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.70
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.12
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.70
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.06
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$15.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.67
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
HEMOGLOBIN ELECTROPHORESIS REF
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2300016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
hemoglobin electrophoresis REF121690
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2200067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
hemoglobin electrophoresis REF121690
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2200067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$18.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$19.87
|
| Rate for Payer: Humana Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.06
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.70
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.12
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.70
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.06
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$15.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.67
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
hemoglobin hba1c REF83036
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
2200848
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$14.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$243.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.45
|
|
|
hemoglobin hba1c REF83036
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
2200848
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$14.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$278.40
|
| Rate for Payer: GEHA Medicare |
$9.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Humana ChoiceCare |
$10.68
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.71
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.51
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.42
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.71
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Medicare |
$8.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.65
|
| Rate for Payer: Zelis Worker's Compensation |
$10.45
|
|
|
HEMOGLOBIN (Hb) Solubility
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
2200343
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.51
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$8.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: GEHA Medicare |
$5.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$6.06
|
| Rate for Payer: Humana Medicare Advantage |
$5.51
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.51
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.37
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.02
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$96.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.51
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Medicare |
$4.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.61
|
| Rate for Payer: Zelis Worker's Compensation |
$6.36
|
|
|
HEMOGLOBIN (Hb) Solubility
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
2200343
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$8.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.36
|
|
|
HEMOGRAM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2205027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$12.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.89
|
|
|
HEMOGRAM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2205027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$12.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.89
|
|
|
HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,919.98 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$2,369.65
|
|
|
HEMORRHOIDECTOMY INTERNAL RUBBER BAND LI
|
Facility
|
OP
|
$2,854.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
20346221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$429.72 |
| Max. Negotiated Rate |
$2,711.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,712.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$429.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Cigna Commercial |
$2,425.90
|
| Rate for Payer: First Health Commercial |
$2,568.60
|
| Rate for Payer: First Health Workers Compensation |
$1,101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,568.60
|
| Rate for Payer: GEHA Commercial |
$2,283.20
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,568.60
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$438.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$2,597.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,997.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,568.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$506.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$438.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,711.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$2,140.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$438.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,654.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$1,141.60
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$779.14
|
|
|
HEMORRHOIDECTOMY INTERNAL RUBBER BAND LI
|
Facility
|
IP
|
$2,854.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
10046221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.14 |
| Max. Negotiated Rate |
$2,711.30 |
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Cigna Commercial |
$2,425.90
|
| Rate for Payer: First Health Commercial |
$2,568.60
|
| Rate for Payer: First Health Workers Compensation |
$1,101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,568.60
|
| Rate for Payer: GEHA Commercial |
$1,997.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,568.60
|
| Rate for Payer: Multiplan All |
$2,597.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,997.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,568.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,711.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,140.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,654.22
|
| Rate for Payer: Zelis Auto |
$1,141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$779.14
|
|
