|
hepatitis c antibody REF140659
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
2236317
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$21.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.52
|
|
|
HEPATITIS C CONFIRMATION (lab only)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
2299112
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$89.30 |
| 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 |
$56.40
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$16.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$75.20
|
| Rate for Payer: GEHA Medicare |
$10.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| 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 |
$85.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.56
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| 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 |
$89.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.66
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.12
|
| Rate for Payer: United Healthcare Commercial |
$79.90
|
| 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 |
$87.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.33
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Medicare |
$8.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.82
|
|
|
HEPATITIS C CONFIRMATION (lab only)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
2299112
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$16.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$65.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Worker's Compensation |
$11.82
|
|
|
hepatitis c genotyping REF550475
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2200331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.83 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$463.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$463.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$367.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$347.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$1,079.20
|
| Rate for Payer: GEHA Medicare |
$257.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Humana ChoiceCare |
$283.19
|
| Rate for Payer: Humana Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$432.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$374.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$257.45
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$437.67
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$432.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$374.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$257.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.30
|
| Rate for Payer: United Healthcare Commercial |
$1,146.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$374.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$257.45
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Medicare |
$218.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$308.94
|
| Rate for Payer: Zelis Worker's Compensation |
$245.48
|
|
|
hepatitis c genotyping REF550475
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2200331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$347.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$944.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Worker's Compensation |
$245.48
|
|
|
HEPATITIS C RNA GENOTYPE 1 NS5A REF
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2300062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$347.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$944.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Worker's Compensation |
$245.48
|
|
|
HEPATITIS C RNA GENOTYPE 1 NS5A REF
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2300062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.83 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$463.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$463.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$367.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$347.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$1,079.20
|
| Rate for Payer: GEHA Medicare |
$257.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Humana ChoiceCare |
$283.19
|
| Rate for Payer: Humana Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$432.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$374.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$257.45
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$437.67
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$432.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$374.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$257.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.30
|
| Rate for Payer: United Healthcare Commercial |
$1,146.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$374.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$257.45
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Medicare |
$218.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$308.94
|
| Rate for Payer: Zelis Worker's Compensation |
$245.48
|
|
|
HEPATITIS C RNA NS3 DRUG RESIS REF
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2300061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.83 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$463.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$463.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$367.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$347.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$1,079.20
|
| Rate for Payer: GEHA Medicare |
$257.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Humana ChoiceCare |
$283.19
|
| Rate for Payer: Humana Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$432.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$374.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$257.45
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$437.67
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$432.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$374.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$257.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.30
|
| Rate for Payer: United Healthcare Commercial |
$1,146.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$374.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$257.45
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Medicare |
$218.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$308.94
|
| Rate for Payer: Zelis Worker's Compensation |
$245.48
|
|
|
HEPATITIS C RNA NS3 DRUG RESIS REF
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
2300061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: First Health Workers Compensation |
$347.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,214.10
|
| Rate for Payer: GEHA Commercial |
$944.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,214.10
|
| Rate for Payer: Multiplan All |
$1,227.59
|
| Rate for Payer: OMNI Networks Commercial |
$944.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,214.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,281.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,254.57
|
| Rate for Payer: Zelis Auto |
$539.60
|
| Rate for Payer: Zelis Worker's Compensation |
$245.48
|
|
|
hepatitis c virus quant rna pcrREF551300
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2299105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.99 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$67.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$674.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.99
|
|
|
hepatitis c virus quant rna pcrREF551300
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2299105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$914.85 |
| 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 |
$577.80
|
| 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 |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$67.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$770.40
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| 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 |
$876.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| 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 |
$914.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$818.55
|
| 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 |
$895.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$47.99
|
|
|
hepatitis D virus ab REF 820201
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
2299208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.16
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$26.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$17.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$18.88
|
| Rate for Payer: Humana Medicare Advantage |
$17.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.16
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.17
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.32
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.82
|
| Rate for Payer: United Healthcare Commercial |
$133.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.16
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$14.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.59
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
hepatitis D virus ab REF 820201
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
2299208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$26.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
hepatitis e virus IgM REF820186
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$12.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$14.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.88
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.90
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.76
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.88
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$10.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.46
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
hepatitis e virus IgM REF820186
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
hepatitis pan ABC w/hcv reflex REF144000
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
2200770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$85.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$85.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$83.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$523.20
|
| Rate for Payer: GEHA Medicare |
$47.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Humana ChoiceCare |
$52.39
|
| Rate for Payer: Humana Medicare Advantage |
$47.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$80.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$69.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$47.63
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.97
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$80.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$69.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$47.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$95.26
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.68
|
| Rate for Payer: United Healthcare Commercial |
$555.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$47.63
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Medicare |
$40.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$57.16
|
| Rate for Payer: Zelis Worker's Compensation |
$59.07
|
|
|
hepatitis pan ABC w/hcv reflex REF144000
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
2200770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.07 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$83.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$457.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Worker's Compensation |
$59.07
|
|
|
HEP A VACCINE, ADULT IM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
8590632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$81.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.00
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
HEP A VACCINE, ADULT IM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
8590632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
HEP A VACC, PED/ADOL, 3 DOSE
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 90634
|
| Hospital Charge Code |
8590634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$618.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
HEP A VACC, PED/ADOL, 3 DOSE
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 90634
|
| Hospital Charge Code |
8590634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$707.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$229.84
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$530.40
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$777.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.00
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
HEPB VACC, ILL PAT 3 DOSE IM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
8590740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$184.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$184.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$184.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$146.11
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$180.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$149.09
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.00
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$172.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$149.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$149.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
HEPB VACC, ILL PAT 3 DOSE IM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
8590740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
HEPB VACC PED/ADOL 3 DOSE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
8590744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$42.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$76.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
HEPB VACC PED/ADOL 3 DOSE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
8590744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.17
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$42.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$34.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Humana ChoiceCare |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.79
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.40
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$95.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
