|
HPV COMBO ASSAY CA SCREEN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT G0476
|
| Hospital Charge Code |
8500102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$91.80
|
| Rate for Payer: First Health Commercial |
$97.20
|
| Rate for Payer: First Health Workers Compensation |
$41.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.20
|
| Rate for Payer: GEHA Commercial |
$86.40
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.20
|
| 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 |
$42.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$98.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$75.60
|
| Rate for Payer: One Health Plan PPO/POS |
$97.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$81.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$100.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$43.20
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$29.48
|
|
|
HPV COMBO ASSAY CA SCREEN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT G0476
|
| Hospital Charge Code |
8500102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$91.80
|
| Rate for Payer: First Health Commercial |
$97.20
|
| Rate for Payer: First Health Workers Compensation |
$41.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.20
|
| Rate for Payer: GEHA Commercial |
$75.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.20
|
| Rate for Payer: Multiplan All |
$98.28
|
| Rate for Payer: OMNI Networks Commercial |
$75.60
|
| Rate for Payer: One Health Plan PPO/POS |
$97.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$102.60
|
| Rate for Payer: Three Rivers Provider Network All |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$100.44
|
| Rate for Payer: Zelis Auto |
$43.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.48
|
|
|
HPV VACCINE 2 VALENT, IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90650
|
| Hospital Charge Code |
8590650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$236.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$236.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.51
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$42.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$87.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Humana ChoiceCare |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.33
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.40
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$220.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$95.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
HPV VACCINE 2 VALENT, IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90650
|
| Hospital Charge Code |
8590650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$42.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$76.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
h pylori ab IgG, serum REF162289
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
2200448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$24.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$16.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$18.54
|
| Rate for Payer: Humana Medicare Advantage |
$16.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.85
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.64
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.70
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.51
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.85
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$14.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.22
|
| Rate for Payer: Zelis Worker's Compensation |
$17.37
|
|
|
h pylori ab IgG, serum REF162289
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
2200448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$24.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.37
|
|
|
h pylori ag, stool REF180764
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
2207073
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$297.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
h pylori ag, stool REF180764
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
2207073
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$340.00
|
| Rate for Payer: GEHA Medicare |
$14.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Humana ChoiceCare |
$15.82
|
| Rate for Payer: Humana Medicare Advantage |
$14.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.38
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.45
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.76
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.09
|
| Rate for Payer: United Healthcare Commercial |
$361.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.38
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Medicare |
$12.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.26
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
H PYLORI STOOL AG AGH
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
2300114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$340.00
|
| Rate for Payer: GEHA Medicare |
$14.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Humana ChoiceCare |
$15.82
|
| Rate for Payer: Humana Medicare Advantage |
$14.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.38
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.45
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.76
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.09
|
| Rate for Payer: United Healthcare Commercial |
$361.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.38
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Medicare |
$12.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.26
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
H PYLORI STOOL AG AGH
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
2300114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$361.25
|
| Rate for Payer: First Health Commercial |
$382.50
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.50
|
| Rate for Payer: GEHA Commercial |
$297.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.50
|
| Rate for Payer: Multiplan All |
$386.75
|
| Rate for Payer: OMNI Networks Commercial |
$297.50
|
| Rate for Payer: One Health Plan PPO/POS |
$382.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.75
|
| Rate for Payer: Three Rivers Provider Network All |
$318.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$395.25
|
| Rate for Payer: Zelis Auto |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
h pylori urea breath test REF180836
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
2239432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$134.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$121.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$121.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.36
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$107.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$76.00
|
| Rate for Payer: GEHA Medicare |
$67.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Humana Medicare Advantage |
$67.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$98.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.36
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.51
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$113.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$98.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$134.72
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.01
|
| Rate for Payer: United Healthcare Commercial |
$80.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.36
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Medicare |
$57.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.83
|
| Rate for Payer: Zelis Worker's Compensation |
$75.81
|
|
|
h pylori urea breath test REF180836
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
2239432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$107.22 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$107.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$66.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.81
|
|
|
HSP IP/OBS D/C DAY MGMT; 30 MIN OR LESS
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
21999419
|
|
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
|
|
|
HSP IP/OBS D/C DAY MGMT; 30 MIN OR LESS
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
21799488
|
|
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
|
|
|
HSP IP/OBS D/C DAY MGMT; 30 MIN OR LESS
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
21999419
|
|
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
|
|
|
HSP IP/OBS D/C DAY MGMT; 30 MIN OR LESS
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
9899238
|
|
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
|
|
|
HSP IP/OBS D/C DAY MGMT; 30 MIN OR LESS
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
21799488
|
|
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
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
21799489
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$244.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$244.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$194.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$197.99
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$228.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$197.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
21799489
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
21999420
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$244.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$244.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$194.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$197.99
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$228.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$197.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
5099239
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$244.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$244.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$194.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$197.99
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$228.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$197.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
5099239
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
21999420
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
HSP IP/OBS D/C DAY MGMT; >30 MINS DOS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
9899239
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
hsv culture and typing REF008250
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
2200210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$48.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$33.86
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$123.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$33.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$37.25
|
| Rate for Payer: Humana Medicare Advantage |
$33.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$56.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$49.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$33.86
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.56
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$56.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$49.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$33.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$67.72
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.18
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$33.86
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$28.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.63
|
| Rate for Payer: Zelis Worker's Compensation |
$87.11
|
|
