|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$1,606.00
|
|
| Hospital Charge Code |
8156405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$438.44 |
| Max. Negotiated Rate |
$1,525.70 |
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$1,365.10
|
| Rate for Payer: First Health Commercial |
$1,445.40
|
| Rate for Payer: First Health Workers Compensation |
$620.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.40
|
| Rate for Payer: GEHA Commercial |
$1,124.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.40
|
| Rate for Payer: Multiplan All |
$1,461.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,525.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,493.58
|
| Rate for Payer: Zelis Auto |
$642.40
|
| Rate for Payer: Zelis Worker's Compensation |
$438.44
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$422.88
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
6156405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$401.74 |
| Rate for Payer: Cash Price |
$253.73
|
| Rate for Payer: Cigna Commercial |
$359.45
|
| Rate for Payer: First Health Commercial |
$380.59
|
| Rate for Payer: First Health Workers Compensation |
$163.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.59
|
| Rate for Payer: GEHA Commercial |
$296.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.59
|
| Rate for Payer: Multiplan All |
$384.82
|
| Rate for Payer: OMNI Networks Commercial |
$296.02
|
| Rate for Payer: One Health Plan PPO/POS |
$380.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.74
|
| Rate for Payer: Three Rivers Provider Network All |
$317.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.28
|
| Rate for Payer: Zelis Auto |
$169.15
|
| Rate for Payer: Zelis Worker's Compensation |
$115.45
|
|
|
IgA (immunoglobulin A) quant REF001784
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2247437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$15.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$9.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$10.23
|
| Rate for Payer: Humana Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.30
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.81
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.60
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.11
|
| Rate for Payer: United Healthcare Commercial |
$263.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$7.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.16
|
| Rate for Payer: Zelis Worker's Compensation |
$10.84
|
|
|
IgA (immunoglobulin A) quant REF001784
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2247437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$15.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.84
|
|
|
IgE total (immunoglobulin E) REF002170
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
2233513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.46
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$28.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$140.80
|
| Rate for Payer: GEHA Medicare |
$16.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Humana ChoiceCare |
$18.11
|
| Rate for Payer: Humana Medicare Advantage |
$16.46
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.46
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.98
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.92
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.13
|
| Rate for Payer: United Healthcare Commercial |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.46
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Medicare |
$13.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.75
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
IgE total (immunoglobulin E) REF002170
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
2233513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$28.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
igf 1 icma REF010363
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
22990795
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.26
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$34.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$21.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$23.39
|
| Rate for Payer: Humana Medicare Advantage |
$21.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.26
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.14
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42.52
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.83
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.26
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$18.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.51
|
| Rate for Payer: Zelis Worker's Compensation |
$24.09
|
|
|
igf 1 icma REF010363
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
22990795
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$34.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.09
|
|
|
igf bp3 REF140152
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
igf bp3 REF140152
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
igg casein REF605081
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
2200803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$10.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$43.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Worker's Compensation |
$7.56
|
|
|
igg casein REF605081
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
2200803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$10.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$49.60
|
| Rate for Payer: GEHA Medicare |
$7.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Humana ChoiceCare |
$8.60
|
| Rate for Payer: Humana Medicare Advantage |
$7.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.82
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.29
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.64
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.82
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Medicare |
$6.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.38
|
| Rate for Payer: Zelis Worker's Compensation |
$7.56
|
|
|
igg gluten REF605082
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
2200804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$10.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$49.60
|
| Rate for Payer: GEHA Medicare |
$7.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Humana ChoiceCare |
$8.60
|
| Rate for Payer: Humana Medicare Advantage |
$7.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.82
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.29
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.64
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.82
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Medicare |
$6.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.38
|
| Rate for Payer: Zelis Worker's Compensation |
$7.56
|
|
|
igg gluten REF605082
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
2200804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$10.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$43.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Worker's Compensation |
$7.56
|
|
|
IGG SUBCALSS 4
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$8.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$8.82
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.02
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.63
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.04
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.02
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$6.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.62
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCALSS 4
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCLASS 1
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$8.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$8.82
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.02
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.63
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.04
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.02
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$6.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.62
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCLASS 1
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCLASS 2
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCLASS 2
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$8.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$8.82
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.02
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.63
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.04
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.02
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$6.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.62
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCLASS 3
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$8.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$8.82
|
| Rate for Payer: Humana Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.02
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.63
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.04
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.02
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$6.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.62
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
IGG SUBCLASS 3
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2299628
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
igg whey REF605142
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
2200802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$10.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$43.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Worker's Compensation |
$7.56
|
|
|
igg whey REF605142
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
2200802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$10.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$49.60
|
| Rate for Payer: GEHA Medicare |
$7.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Humana ChoiceCare |
$8.60
|
| Rate for Payer: Humana Medicare Advantage |
$7.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.82
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.29
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.64
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.82
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Medicare |
$6.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.38
|
| Rate for Payer: Zelis Worker's Compensation |
$7.56
|
|
|
IgM (immunoglobulin M) quant REF001792
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2247439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$15.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.84
|
|
