|
HORIZON CLINIC COV19 AND INFLU A&B
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 87428
|
| Hospital Charge Code |
7300030
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$83.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$70.29
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: GEHA Medicare |
$70.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Humana ChoiceCare |
$77.32
|
| Rate for Payer: Humana Medicare Advantage |
$70.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$118.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$70.29
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.49
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$98.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$85.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$70.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$140.58
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$68.88
|
| Rate for Payer: United Healthcare Commercial |
$279.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$70.29
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Medicare |
$59.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.35
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
HORIZON CLINIC GLUCOSE POCT
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
7300029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$37.60
|
| Rate for Payer: GEHA Medicare |
$5.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.04
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.57
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.08
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.94
|
| Rate for Payer: United Healthcare Commercial |
$39.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.04
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Medicare |
$4.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.05
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
HORIZON CLINIC GLUCOSE POCT
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
7300029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$32.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
HORIZON CLINIC RAPID STREP
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
7300031
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
HORIZON CLINIC RAPID STREP
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
7300031
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.81
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$16.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$18.49
|
| Rate for Payer: Humana Medicare Advantage |
$16.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.81
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.58
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.62
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.81
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$14.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.17
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
HORIZON CLINIC URINALYSIS BY DIPSTICK
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
7300032
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$4.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: GEHA Medicare |
$3.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$3.83
|
| Rate for Payer: Humana Medicare Advantage |
$3.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.48
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.92
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6.96
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.41
|
| Rate for Payer: United Healthcare Commercial |
$32.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.48
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Medicare |
$2.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3.12
|
|
|
HORIZON CLINIC URINALYSIS BY DIPSTICK
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
7300032
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$4.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.12
|
|
|
HORIZON CLINIC URINE PREGNANCY TEST
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
7300033
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
HORIZON CLINIC URINE PREGNANCY TEST
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
7300033
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
horse fly, IgE REF602898
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
horse fly, IgE REF602898
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
HOS DISCHARGE - 30 MIN
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
5099238
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: First Health Workers Compensation |
$86.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Worker's Compensation |
$60.88
|
|
|
HOS DISCHARGE - 30 MIN
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
5099238
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$173.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$173.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$137.46
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: First Health Workers Compensation |
$86.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$140.26
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.80
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$161.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$140.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$140.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.50
|
| Rate for Payer: Zelis Worker's Compensation |
$60.88
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
7800463
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$462.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
1999335
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$121.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$251.20
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$104.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$120.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$104.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$85.72
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
7800463
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$528.80
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$104.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$120.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$104.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
9670463
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$528.80
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$104.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$120.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$104.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
9670463
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$462.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
1997603
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$462.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
1999335
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$121.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$219.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Worker's Compensation |
$85.72
|
|
|
HOSPITAL OUTPT CLINIC VISIT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
1997603
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$561.85
|
| Rate for Payer: First Health Commercial |
$594.90
|
| Rate for Payer: First Health Workers Compensation |
$255.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.90
|
| Rate for Payer: GEHA Commercial |
$528.80
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.90
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$104.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$601.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$462.70
|
| Rate for Payer: One Health Plan PPO/POS |
$594.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$120.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$104.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$495.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$614.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$264.40
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$180.45
|
|
|
H PAPILLOMA VACC 3 DOSE I
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
8590649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$238.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$238.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$189.32
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$121.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$251.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Humana ChoiceCare |
$81.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$193.18
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$188.40
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$223.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$193.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$276.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.00
|
| Rate for Payer: Zelis Worker's Compensation |
$85.72
|
|
|
H PAPILLOMA VACC 3 DOSE I
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
8590649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$121.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$219.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Worker's Compensation |
$85.72
|
|
|
hp pla2 REF500314
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT 81105
|
| Hospital Charge Code |
2200733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.89 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$183.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$183.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$145.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: First Health Workers Compensation |
$160.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: GEHA Medicare |
$122.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$134.44
|
| Rate for Payer: Humana Medicare Advantage |
$122.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$148.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.22
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.77
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$171.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$148.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.44
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.78
|
| Rate for Payer: United Healthcare Commercial |
$317.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$148.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.22
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Medicare |
$103.89
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.66
|
| Rate for Payer: Zelis Worker's Compensation |
$113.46
|
|
|
hp pla2 REF500314
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 81105
|
| Hospital Charge Code |
2200733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.46 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: First Health Workers Compensation |
$160.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Worker's Compensation |
$113.46
|
|
