|
hiv 1 rna pcr viral load/quant REF550880
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
22990845
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$116.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$396.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$82.03
|
|
|
hiv 1 rna pcr viral load/quant REF550880
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
22990845
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.33 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$153.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$153.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$116.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: GEHA Medicare |
$85.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Humana ChoiceCare |
$93.61
|
| Rate for Payer: Humana Medicare Advantage |
$85.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$142.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$123.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.10
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.67
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$142.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$123.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.20
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.40
|
| Rate for Payer: United Healthcare Commercial |
$481.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.10
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Medicare |
$72.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.12
|
| Rate for Payer: Zelis Worker's Compensation |
$82.03
|
|
|
HIZENTRA 20% 10 GM/50 ML
|
Facility
|
OP
|
$3,837.00
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
3302883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$3,645.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,302.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.34
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna Commercial |
$3,261.45
|
| Rate for Payer: First Health Commercial |
$3,453.30
|
| Rate for Payer: First Health Workers Compensation |
$1,481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,453.30
|
| Rate for Payer: GEHA Commercial |
$15.77
|
| Rate for Payer: GEHA Medicare |
$14.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,453.30
|
| Rate for Payer: Humana ChoiceCare |
$15.77
|
| Rate for Payer: Humana Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.34
|
| Rate for Payer: Multiplan All |
$3,491.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,685.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,453.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,645.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.68
|
| Rate for Payer: Three Rivers Provider Network All |
$2,877.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,568.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.34
|
| Rate for Payer: Zelis Auto |
$1,534.80
|
| Rate for Payer: Zelis Medicare |
$12.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.21
|
| Rate for Payer: Zelis Worker's Compensation |
$1,047.50
|
|
|
HIZENTRA 20% 10 GM/50 ML
|
Facility
|
IP
|
$3,837.00
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
3302883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,047.50 |
| Max. Negotiated Rate |
$3,645.15 |
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna Commercial |
$3,261.45
|
| Rate for Payer: First Health Commercial |
$3,453.30
|
| Rate for Payer: First Health Workers Compensation |
$1,481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,453.30
|
| Rate for Payer: GEHA Commercial |
$2,685.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,453.30
|
| Rate for Payer: Multiplan All |
$3,491.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,685.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,453.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,645.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,877.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,568.41
|
| Rate for Payer: Zelis Auto |
$1,534.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,047.50
|
|
|
HIZENTRA 20% 1GM/5ML
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
3302885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.34
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$15.77
|
| Rate for Payer: GEHA Medicare |
$14.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Humana ChoiceCare |
$15.77
|
| Rate for Payer: Humana Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.34
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.38
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.68
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.34
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Medicare |
$12.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.21
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
HIZENTRA 20% 1GM/5ML
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
3302885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
HIZENTRA 20% 4GM/20ML
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
3302884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.06 |
| Max. Negotiated Rate |
$1,799.30 |
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cigna Commercial |
$1,609.90
|
| Rate for Payer: First Health Commercial |
$1,704.60
|
| Rate for Payer: First Health Workers Compensation |
$731.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,704.60
|
| Rate for Payer: GEHA Commercial |
$1,325.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,704.60
|
| Rate for Payer: Multiplan All |
$1,723.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,704.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,799.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,420.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,761.42
|
| Rate for Payer: Zelis Auto |
$757.60
|
| Rate for Payer: Zelis Worker's Compensation |
$517.06
|
|
|
HIZENTRA 20% 4GM/20ML
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
3302884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$1,799.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,136.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.34
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cigna Commercial |
$1,609.90
|
| Rate for Payer: First Health Commercial |
$1,704.60
|
| Rate for Payer: First Health Workers Compensation |
$731.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,704.60
|
| Rate for Payer: GEHA Commercial |
$15.77
|
| Rate for Payer: GEHA Medicare |
$14.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,704.60
|
| Rate for Payer: Humana ChoiceCare |
$15.77
|
| Rate for Payer: Humana Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.34
|
| Rate for Payer: Multiplan All |
$1,723.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,704.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,799.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.68
|
| Rate for Payer: Three Rivers Provider Network All |
$1,420.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,761.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.34
|
| Rate for Payer: Zelis Auto |
$757.60
|
| Rate for Payer: Zelis Medicare |
$12.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.21
|
| Rate for Payer: Zelis Worker's Compensation |
$517.06
|
|
|
hla b 27 disease association REF006924
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
2299113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$74.33
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: First Health Commercial |
$340.20
|
| Rate for Payer: First Health Workers Compensation |
$109.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$340.20
|
| Rate for Payer: GEHA Commercial |
$302.40
|
| Rate for Payer: GEHA Medicare |
$74.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$340.20
|
| Rate for Payer: Humana ChoiceCare |
$81.76
|
| Rate for Payer: Humana Medicare Advantage |
$74.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$108.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$74.33
|
| Rate for Payer: Multiplan All |
$343.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$126.36
|
| Rate for Payer: OMNI Networks Commercial |
$264.60
|
| Rate for Payer: One Health Plan PPO/POS |
$340.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$124.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$108.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$74.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$148.66
|
| Rate for Payer: Three Rivers Provider Network All |
$283.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.84
|
| Rate for Payer: United Healthcare Commercial |
$321.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$351.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$74.33
|
| Rate for Payer: Zelis Auto |
$151.20
|
| Rate for Payer: Zelis Medicare |
$63.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.20
|
| Rate for Payer: Zelis Worker's Compensation |
$77.17
|
|
|
hla b 27 disease association REF006924
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
2299113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: First Health Commercial |
$340.20
|
| Rate for Payer: First Health Workers Compensation |
$109.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$340.20
|
| Rate for Payer: GEHA Commercial |
$264.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$340.20
|
| Rate for Payer: Multiplan All |
$343.98
|
| Rate for Payer: OMNI Networks Commercial |
$264.60
|
| Rate for Payer: One Health Plan PPO/POS |
$340.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$359.10
|
| Rate for Payer: Three Rivers Provider Network All |
$283.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$351.54
|
| Rate for Payer: Zelis Auto |
$151.20
|
| Rate for Payer: Zelis Worker's Compensation |
$77.17
|
|
|
hla b 51 disease association REF 167389
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
2232294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.21 |
| Max. Negotiated Rate |
$717.25 |
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$641.75
|
| Rate for Payer: First Health Commercial |
$679.50
|
| Rate for Payer: First Health Workers Compensation |
$167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$679.50
|
| Rate for Payer: GEHA Commercial |
$528.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$679.50
|
| Rate for Payer: Multiplan All |
$687.05
|
| Rate for Payer: OMNI Networks Commercial |
$528.50
|
| Rate for Payer: One Health Plan PPO/POS |
$679.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$717.25
|
| Rate for Payer: Three Rivers Provider Network All |
$566.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$702.15
|
| Rate for Payer: Zelis Auto |
$302.00
|
| Rate for Payer: Zelis Worker's Compensation |
$118.21
|
|
|
hla b 51 disease association REF 167389
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
2232294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.32 |
| Max. Negotiated Rate |
$717.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$229.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$453.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$229.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$181.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$127.43
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$641.75
|
| Rate for Payer: First Health Commercial |
$679.50
|
| Rate for Payer: First Health Workers Compensation |
$167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$679.50
|
| Rate for Payer: GEHA Commercial |
$604.00
|
| Rate for Payer: GEHA Medicare |
$127.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$679.50
|
| Rate for Payer: Humana ChoiceCare |
$140.17
|
| Rate for Payer: Humana Medicare Advantage |
$127.43
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$214.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$185.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$127.43
|
| Rate for Payer: Multiplan All |
$687.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$216.63
|
| Rate for Payer: OMNI Networks Commercial |
$528.50
|
| Rate for Payer: One Health Plan PPO/POS |
$679.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$214.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$185.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$127.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$717.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$254.86
|
| Rate for Payer: Three Rivers Provider Network All |
$566.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.88
|
| Rate for Payer: United Healthcare Commercial |
$641.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$185.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$702.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$127.43
|
| Rate for Payer: Zelis Auto |
$302.00
|
| Rate for Payer: Zelis Medicare |
$108.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.92
|
| Rate for Payer: Zelis Worker's Compensation |
$118.21
|
|
|
hla class 1 ab id REF168058
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
2200313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$258.66 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$582.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$582.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$461.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$323.75
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$365.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: GEHA Medicare |
$323.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$356.12
|
| Rate for Payer: Humana Medicare Advantage |
$323.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$543.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$471.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$323.75
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.38
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$543.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$471.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$323.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$647.50
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$317.27
|
| Rate for Payer: United Healthcare Commercial |
$711.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$471.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$323.75
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Medicare |
$275.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$388.50
|
| Rate for Payer: Zelis Worker's Compensation |
$258.66
|
|
|
hla class 1 ab id REF168058
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
2200313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$258.66 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$365.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$258.66
|
|
|
hla class ii ab id REF168060
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
2200314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.29 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
|
|
hla class ii ab id REF168060
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
2200314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.29 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$586.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$586.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$464.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$325.80
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: GEHA Medicare |
$325.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$358.38
|
| Rate for Payer: Humana Medicare Advantage |
$325.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$547.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$474.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$325.80
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$553.86
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$547.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$474.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$651.60
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$319.28
|
| Rate for Payer: United Healthcare Commercial |
$711.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$474.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$325.80
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Medicare |
$276.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$390.96
|
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
|
|
HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST A
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96150
|
| Hospital Charge Code |
21700030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST A
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96150
|
| Hospital Charge Code |
21700030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.60
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST A
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 96150
|
| Hospital Charge Code |
21900139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.60
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST A
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 96150
|
| Hospital Charge Code |
21900139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
HLTH BEHAVIOR IVNTJ INDIV F2F EA AD 15M
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
8596159
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$55.25
|
| Rate for Payer: First Health Commercial |
$58.50
|
| Rate for Payer: First Health Workers Compensation |
$25.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.50
|
| Rate for Payer: GEHA Commercial |
$45.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.50
|
| Rate for Payer: Multiplan All |
$59.15
|
| Rate for Payer: OMNI Networks Commercial |
$45.50
|
| Rate for Payer: One Health Plan PPO/POS |
$58.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.75
|
| Rate for Payer: Three Rivers Provider Network All |
$48.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.45
|
| Rate for Payer: Zelis Auto |
$26.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.75
|
|
|
HLTH BEHAVIOR IVNTJ INDIV F2F EA AD 15M
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
8596159
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$55.25
|
| Rate for Payer: First Health Commercial |
$58.50
|
| Rate for Payer: First Health Workers Compensation |
$25.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.50
|
| Rate for Payer: GEHA Commercial |
$52.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.50
|
| Rate for Payer: Humana ChoiceCare |
$16.90
|
| Rate for Payer: Multiplan All |
$59.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.00
|
| Rate for Payer: OMNI Networks Commercial |
$45.50
|
| Rate for Payer: One Health Plan PPO/POS |
$58.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.75
|
| Rate for Payer: Three Rivers Provider Network All |
$48.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$57.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.45
|
| Rate for Payer: Zelis Auto |
$26.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.50
|
| Rate for Payer: Zelis Worker's Compensation |
$17.75
|
|
|
HOLTER MONITOR-ANALYSIS AND REPORT
|
Facility
|
OP
|
$1,617.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4009007
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$1,536.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cigna Commercial |
$1,374.45
|
| Rate for Payer: First Health Commercial |
$1,455.30
|
| Rate for Payer: First Health Workers Compensation |
$624.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,455.30
|
| Rate for Payer: GEHA Commercial |
$1,293.60
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,455.30
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$1,471.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,131.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,455.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,536.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,212.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Commercial |
$1,374.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,503.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$646.80
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$441.44
|
|
|
HOLTER MONITOR-ANALYSIS AND REPORT
|
Facility
|
IP
|
$1,617.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4009007
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$441.44 |
| Max. Negotiated Rate |
$1,536.15 |
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cigna Commercial |
$1,374.45
|
| Rate for Payer: First Health Commercial |
$1,455.30
|
| Rate for Payer: First Health Workers Compensation |
$624.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,455.30
|
| Rate for Payer: GEHA Commercial |
$1,131.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,455.30
|
| Rate for Payer: Multiplan All |
$1,471.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,131.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,455.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,536.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,212.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,503.81
|
| Rate for Payer: Zelis Auto |
$646.80
|
| Rate for Payer: Zelis Worker's Compensation |
$441.44
|
|
|
HOLTER MONITOR-REC-CONN&DISC UPTO 48 HR
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
4000025
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$331.69 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna Commercial |
$1,032.75
|
| Rate for Payer: First Health Commercial |
$1,093.50
|
| Rate for Payer: First Health Workers Compensation |
$469.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,093.50
|
| Rate for Payer: GEHA Commercial |
$850.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,093.50
|
| Rate for Payer: Multiplan All |
$1,105.65
|
| Rate for Payer: OMNI Networks Commercial |
$850.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,093.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,154.25
|
| Rate for Payer: Three Rivers Provider Network All |
$911.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.95
|
| Rate for Payer: Zelis Auto |
$486.00
|
| Rate for Payer: Zelis Worker's Compensation |
$331.69
|
|
