|
hepatitis a ab IgM REF006734
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
22990900
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$22.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$118.40
|
| Rate for Payer: GEHA Medicare |
$11.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Humana ChoiceCare |
$12.39
|
| Rate for Payer: Humana Medicare Advantage |
$11.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.26
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.14
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$22.52
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.03
|
| Rate for Payer: United Healthcare Commercial |
$125.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.26
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Medicare |
$9.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.51
|
| Rate for Payer: Zelis Worker's Compensation |
$15.89
|
|
|
hepatitis a ab IgM REF006734
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
22990900
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$22.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$103.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.89
|
|
|
hepatitis a ab total igg REF006726
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
2236294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$83.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$24.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$111.20
|
| Rate for Payer: GEHA Medicare |
$12.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Humana ChoiceCare |
$13.63
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.39
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.06
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.78
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$118.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.39
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Medicare |
$10.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.87
|
| Rate for Payer: Zelis Worker's Compensation |
$17.46
|
|
|
hepatitis a ab total igg REF006726
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
2236294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$24.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$97.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.46
|
|
|
HEPATITIS A-HEP B VACCINE
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
3300404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.76
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Humana ChoiceCare |
$107.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.10
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$247.80
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$363.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$206.50
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
HEPATITIS A-HEP B VACCINE
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
3300404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$289.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
hepatitis b core ab IgM REF016881
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
2286705
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.18
|
| 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 |
$21.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.77
|
| 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 |
$25.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: GEHA Medicare |
$11.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$12.95
|
| Rate for Payer: Humana Medicare Advantage |
$11.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.77
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.01
|
| 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 |
$19.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.54
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$86.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.77
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Medicare |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.12
|
| Rate for Payer: Zelis Worker's Compensation |
$17.91
|
|
|
hepatitis b core ab IgM REF016881
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
2286705
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.91 |
| 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 |
$25.32
|
| 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 |
$17.91
|
|
|
hepatitis B core ab total REF006718
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
22990337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$24.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$15.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$17.29
|
|
|
hepatitis B core ab total REF006718
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
22990337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$24.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.29
|
|
|
hepatitis be ab REF006635
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
2247431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.82
|
| 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 |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.57
|
| 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 |
$22.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: GEHA Medicare |
$11.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$12.73
|
| Rate for Payer: Humana Medicare Advantage |
$11.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.57
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.67
|
| 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 |
$19.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.14
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.34
|
| Rate for Payer: United Healthcare Commercial |
$96.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.57
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Medicare |
$9.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.88
|
| Rate for Payer: Zelis Worker's Compensation |
$15.76
|
|
|
hepatitis be ab REF006635
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
2247431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.76 |
| 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 |
$22.28
|
| 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 |
$15.76
|
|
|
hepatitis be antigen REF006619
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
2247432
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: First Health Commercial |
$86.40
|
| Rate for Payer: First Health Workers Compensation |
$18.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$86.40
|
| Rate for Payer: GEHA Commercial |
$76.80
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$86.40
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$87.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$67.20
|
| Rate for Payer: One Health Plan PPO/POS |
$86.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$91.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$72.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$81.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$89.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$38.40
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$13.29
|
|
|
hepatitis be antigen REF006619
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
2247432
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: First Health Commercial |
$86.40
|
| Rate for Payer: First Health Workers Compensation |
$18.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$86.40
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$86.40
|
| Rate for Payer: Multiplan All |
$87.36
|
| Rate for Payer: OMNI Networks Commercial |
$67.20
|
| Rate for Payer: One Health Plan PPO/POS |
$86.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$91.20
|
| Rate for Payer: Three Rivers Provider Network All |
$72.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$89.28
|
| Rate for Payer: Zelis Auto |
$38.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.29
|
|
|
hepatitis b surf ab quant REF006530
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2299107
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
hepatitis b surf ab quant REF006530
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2299107
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
hepatitis b surface ab qual REF006395
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
2246706
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$20.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.19
|
|
|
hepatitis b surface ab qual REF006395
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
2246706
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$20.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$10.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$11.81
|
| Rate for Payer: Humana Medicare Advantage |
$10.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.74
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.26
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.48
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.74
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$9.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.89
|
| Rate for Payer: Zelis Worker's Compensation |
$14.19
|
|
|
hepatitis b surface ag w/ rflx REF006510
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
2299108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.52 |
| 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 |
$16.30
|
| 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 |
$11.52
|
|
|
hepatitis b surface ag w/ rflx REF006510
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
2299108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.60
|
| 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 |
$18.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.33
|
| 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 |
$16.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: GEHA Medicare |
$10.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$11.36
|
| Rate for Payer: Humana Medicare Advantage |
$10.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.33
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.56
|
| 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 |
$17.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.66
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.12
|
| Rate for Payer: United Healthcare Commercial |
$86.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.33
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Medicare |
$8.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.52
|
|
|
HEPATITIS B VACCINE (RECOMBINANT)
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
3300405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$92.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$92.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.04
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$77.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Humana ChoiceCare |
$81.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.53
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$187.20
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
HEPATITIS B VACCINE (RECOMBINANT)
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
3300405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
hepatitis b virus quant dna rt REF551745
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
2247433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$69.52 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$53.55
|
| Rate for Payer: First Health Commercial |
$56.70
|
| Rate for Payer: First Health Workers Compensation |
$69.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$56.70
|
| Rate for Payer: GEHA Commercial |
$44.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$56.70
|
| Rate for Payer: Multiplan All |
$57.33
|
| Rate for Payer: OMNI Networks Commercial |
$44.10
|
| Rate for Payer: One Health Plan PPO/POS |
$56.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$59.85
|
| Rate for Payer: Three Rivers Provider Network All |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$58.59
|
| Rate for Payer: Zelis Auto |
$25.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.15
|
|
|
hepatitis b virus quant dna rt REF551745
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
2247433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$85.68 |
| 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 |
$37.80
|
| 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 |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$53.55
|
| Rate for Payer: First Health Commercial |
$56.70
|
| Rate for Payer: First Health Workers Compensation |
$69.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$56.70
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$56.70
|
| 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 |
$57.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$44.10
|
| Rate for Payer: One Health Plan PPO/POS |
$56.70
|
| 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 |
$59.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$47.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$53.55
|
| 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 |
$58.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$25.20
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$49.15
|
|
|
hepatitis c antibody REF140659
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
2236317
|
|
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
|
|
