|
hereditary hemochromatosis dna REF511345
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
22990925
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.56 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$98.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$388.80
|
| Rate for Payer: GEHA Medicare |
$65.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Humana ChoiceCare |
$71.90
|
| Rate for Payer: Humana Medicare Advantage |
$65.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$109.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$65.36
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$111.11
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$65.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$130.72
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$65.36
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Medicare |
$55.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.43
|
| Rate for Payer: Zelis Worker's Compensation |
$69.39
|
|
|
hereditary hemochromatosis dna REF511345
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
22990925
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$98.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$340.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Worker's Compensation |
$69.39
|
|
|
HERNIA NO MESH PROCEDURE
|
Facility
|
OP
|
$7,613.00
|
|
| Hospital Charge Code |
6100006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,903.25 |
| Max. Negotiated Rate |
$7,232.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,567.80
|
| Rate for Payer: Cash Price |
$4,567.80
|
| Rate for Payer: Cigna Commercial |
$6,471.05
|
| Rate for Payer: First Health Commercial |
$6,851.70
|
| Rate for Payer: First Health Workers Compensation |
$2,939.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,851.70
|
| Rate for Payer: GEHA Commercial |
$6,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,851.70
|
| Rate for Payer: Humana ChoiceCare |
$1,979.38
|
| Rate for Payer: Multiplan All |
$6,927.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,567.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,329.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,851.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,232.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,709.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,699.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,903.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,080.09
|
| Rate for Payer: Zelis Auto |
$3,045.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,806.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,078.35
|
|
|
HERNIA NO MESH PROCEDURE
|
Facility
|
IP
|
$7,613.00
|
|
| Hospital Charge Code |
6100006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,078.35 |
| Max. Negotiated Rate |
$7,232.35 |
| Rate for Payer: Cash Price |
$4,567.80
|
| Rate for Payer: Cigna Commercial |
$6,471.05
|
| Rate for Payer: First Health Commercial |
$6,851.70
|
| Rate for Payer: First Health Workers Compensation |
$2,939.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,851.70
|
| Rate for Payer: GEHA Commercial |
$5,329.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,851.70
|
| Rate for Payer: Multiplan All |
$6,927.83
|
| Rate for Payer: OMNI Networks Commercial |
$5,329.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,851.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,232.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,709.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,080.09
|
| Rate for Payer: Zelis Auto |
$3,045.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,078.35
|
|
|
HERNIA REPAIR W/MESH
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
6149568
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.75 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$568.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Humana ChoiceCare |
$184.86
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$426.60
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$625.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$355.50
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
HERNIA REPAIR W/MESH
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
6149568
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$497.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
herpes simplex virus 1/2 IgM DO not use
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
2299277
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: GEHA Medicare |
$14.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$15.83
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.39
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.46
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.78
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.39
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Medicare |
$12.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.27
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
herpes simplex virus 1/2 IgM DO not use
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
2299277
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
herpes simplex virus 1 IgG REF164897
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
2299271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$20.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.80
|
|
|
herpes simplex virus 1 IgG REF164897
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
2299271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$20.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: GEHA Medicare |
$13.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$14.51
|
| Rate for Payer: Humana Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.19
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.42
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.38
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.19
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Medicare |
$11.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.83
|
| Rate for Payer: Zelis Worker's Compensation |
$14.80
|
|
|
herpes simplex virus 2 IgG REF163033
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2200702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$19.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$21.29
|
| Rate for Payer: Humana Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.35
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.90
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38.70
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.35
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$16.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.22
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
herpes simplex virus 2 IgG REF163033
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
2200702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
HESPAN 500ML
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
NDC 00264196510
|
| Hospital Charge Code |
3301119
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$39.52
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$91.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$133.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$76.00
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
HESPAN 500ML
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
NDC 00264196510
|
| Hospital Charge Code |
3301119
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$144.40 |
| 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 |
$58.69
|
| 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 |
$41.50
|
|
|
HEXACHLOROPHENE LIQ 3%
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 00024153548
|
| Hospital Charge Code |
3300406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: First Health Workers Compensation |
$54.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$98.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Worker's Compensation |
$38.49
|
|
|
HEXACHLOROPHENE LIQ 3%
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 00024153548
|
| Hospital Charge Code |
3300406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: First Health Workers Compensation |
$54.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.60
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.50
|
| Rate for Payer: Zelis Worker's Compensation |
$38.49
|
|
|
hhv-6 dna pcr REF138479
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
2200721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$303.45
|
| Rate for Payer: First Health Commercial |
$321.30
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$321.30
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$321.30
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$324.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$249.90
|
| Rate for Payer: One Health Plan PPO/POS |
$321.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$339.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$267.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$303.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$142.80
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
hhv-6 dna pcr REF138479
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
2200721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$303.45
|
| Rate for Payer: First Health Commercial |
$321.30
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$321.30
|
| Rate for Payer: GEHA Commercial |
$249.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$321.30
|
| Rate for Payer: Multiplan All |
$324.87
|
| Rate for Payer: OMNI Networks Commercial |
$249.90
|
| Rate for Payer: One Health Plan PPO/POS |
$321.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$339.15
|
| Rate for Payer: Three Rivers Provider Network All |
$267.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.01
|
| Rate for Payer: Zelis Auto |
$142.80
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
HIB VACCINE, PRP-OMP, IM
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
8590647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$277.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
HIB VACCINE, PRP-OMP, IM
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
8590647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$317.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Humana ChoiceCare |
$103.22
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$238.20
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$349.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$99.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$198.50
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
HI ENRGY ESWT PLANTAR FASCIA
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 28890
|
| Hospital Charge Code |
6128890
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$3,212.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: First Health Workers Compensation |
$220.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$456.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$155.61
|
|
|
HI ENRGY ESWT PLANTAR FASCIA
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 28890
|
| Hospital Charge Code |
6128890
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: First Health Workers Compensation |
$220.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$399.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Worker's Compensation |
$155.61
|
|
|
HIGH INTEN BEH COUNS STD 30M
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT G0445
|
| Hospital Charge Code |
23500024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
HIGH INTEN BEH COUNS STD 30M
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT G0445
|
| Hospital Charge Code |
23500024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$59.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
highsensitivity crp REF120766
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
2299825
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$48.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$12.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$14.24
|
| Rate for Payer: Humana Medicare Advantage |
$12.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.95
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.02
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.90
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.69
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.95
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$11.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.54
|
| Rate for Payer: Zelis Worker's Compensation |
$33.99
|
|
