|
IgM (immunoglobulin M) quant REF001792
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2247439
|
|
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
|
|
|
ILEOSTOMY/JEJUNOSTOMY
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 44310
|
| Hospital Charge Code |
6144310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$598.69 |
| Max. Negotiated Rate |
$2,083.35 |
| Rate for Payer: Cash Price |
$1,315.80
|
| Rate for Payer: Cigna Commercial |
$1,864.05
|
| Rate for Payer: First Health Commercial |
$1,973.70
|
| Rate for Payer: First Health Workers Compensation |
$846.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,973.70
|
| Rate for Payer: GEHA Commercial |
$1,535.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,973.70
|
| Rate for Payer: Multiplan All |
$1,995.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,973.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,083.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,644.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,039.49
|
| Rate for Payer: Zelis Auto |
$877.20
|
| Rate for Payer: Zelis Worker's Compensation |
$598.69
|
|
|
ILEOSTOMY/JEJUNOSTOMY
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 44310
|
| Hospital Charge Code |
6144310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.25 |
| Max. Negotiated Rate |
$2,083.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,315.80
|
| Rate for Payer: Cash Price |
$1,315.80
|
| Rate for Payer: Cigna Commercial |
$1,864.05
|
| Rate for Payer: First Health Commercial |
$1,973.70
|
| Rate for Payer: First Health Workers Compensation |
$846.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,973.70
|
| Rate for Payer: GEHA Commercial |
$1,754.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,973.70
|
| Rate for Payer: Humana ChoiceCare |
$570.18
|
| Rate for Payer: Multiplan All |
$1,995.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,315.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,973.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,083.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,644.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,929.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,039.49
|
| Rate for Payer: Zelis Auto |
$877.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,096.50
|
| Rate for Payer: Zelis Worker's Compensation |
$598.69
|
|
|
ILIAC BONE GRAFT MICROVASC
|
Facility
|
OP
|
$5,517.00
|
|
|
Service Code
|
CPT 20956
|
| Hospital Charge Code |
6120956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,379.25 |
| Max. Negotiated Rate |
$5,241.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,310.20
|
| Rate for Payer: Cash Price |
$3,310.20
|
| Rate for Payer: Cigna Commercial |
$4,689.45
|
| Rate for Payer: First Health Commercial |
$4,965.30
|
| Rate for Payer: First Health Workers Compensation |
$2,130.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,965.30
|
| Rate for Payer: GEHA Commercial |
$4,413.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,965.30
|
| Rate for Payer: Humana ChoiceCare |
$1,434.42
|
| Rate for Payer: Multiplan All |
$5,020.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,310.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,861.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,965.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,241.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,137.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,854.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,379.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,130.81
|
| Rate for Payer: Zelis Auto |
$2,206.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,758.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,506.14
|
|
|
ILIAC BONE GRAFT MICROVASC
|
Facility
|
IP
|
$5,517.00
|
|
|
Service Code
|
CPT 20956
|
| Hospital Charge Code |
6120956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,506.14 |
| Max. Negotiated Rate |
$5,241.15 |
| Rate for Payer: Cash Price |
$3,310.20
|
| Rate for Payer: Cigna Commercial |
$4,689.45
|
| Rate for Payer: First Health Commercial |
$4,965.30
|
| Rate for Payer: First Health Workers Compensation |
$2,130.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,965.30
|
| Rate for Payer: GEHA Commercial |
$3,861.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,965.30
|
| Rate for Payer: Multiplan All |
$5,020.47
|
| Rate for Payer: OMNI Networks Commercial |
$3,861.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,965.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,241.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,137.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,130.81
|
| Rate for Payer: Zelis Auto |
$2,206.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,506.14
|
|
|
ILIAC REVASC
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
6137220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$10,827.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,413.82
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: GEHA Medicare |
$5,413.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$5,955.20
|
| Rate for Payer: Humana Medicare Advantage |
$5,413.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,095.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,413.82
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,203.49
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,413.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,827.64
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,305.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,413.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,413.82
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Medicare |
$4,601.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,496.58
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
ILIAC REVASC
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
6137220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
6137222
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
6137222
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$5,549.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$158.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$365.40
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$535.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$304.50
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
ILIAC REVASC W/STENT
|
Facility
|
IP
|
$1,618.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
6137221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.71 |
| Max. Negotiated Rate |
$1,537.10 |
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cigna Commercial |
$1,375.30
|
| Rate for Payer: First Health Commercial |
$1,456.20
|
| Rate for Payer: First Health Workers Compensation |
$624.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,456.20
|
| Rate for Payer: GEHA Commercial |
$1,132.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,456.20
|
| Rate for Payer: Multiplan All |
$1,472.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,132.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,456.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,537.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,213.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,504.74
|
| Rate for Payer: Zelis Auto |
$647.20
|
| Rate for Payer: Zelis Worker's Compensation |
$441.71
|
|
|
ILIAC REVASC W/STENT
|
Facility
|
OP
|
$1,618.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
6137221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.71 |
| Max. Negotiated Rate |
$21,536.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$970.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,768.32
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cigna Commercial |
$1,375.30
|
| Rate for Payer: First Health Commercial |
$1,456.20
|
| Rate for Payer: First Health Workers Compensation |
$624.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,456.20
|
| Rate for Payer: GEHA Commercial |
$1,294.40
|
| Rate for Payer: GEHA Medicare |
$10,768.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,456.20
|
| Rate for Payer: Humana ChoiceCare |
$11,845.15
|
| Rate for Payer: Humana Medicare Advantage |
$10,768.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18,090.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,768.32
|
| Rate for Payer: Multiplan All |
$1,472.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18,306.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,132.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,456.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,768.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,537.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21,536.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,213.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,552.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,768.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,504.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10,768.32
|
| Rate for Payer: Zelis Auto |
$647.20
|
| Rate for Payer: Zelis Medicare |
$9,153.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,921.98
|
| Rate for Payer: Zelis Worker's Compensation |
$441.71
|
|
|
ILIAC REVASC W/STENT ADD-ON
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
6137223
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
ILIAC REVASC W/STENT ADD-ON
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
6137223
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$5,549.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Humana ChoiceCare |
$180.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$417.60
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$612.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$348.00
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
IM ADM ANY ROUTE 1ST VAC/T
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
8590460
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
IM ADM ANY ROUTE 1ST VAC/T
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
8590460
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
IM ADM INTRANSL/ORAL EA VACCINE
|
Facility
|
OP
|
$33.33
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
7290474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: First Health Commercial |
$30.00
|
| Rate for Payer: First Health Workers Compensation |
$12.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.00
|
| Rate for Payer: GEHA Commercial |
$26.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.00
|
| Rate for Payer: Humana ChoiceCare |
$8.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$30.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.00
|
| Rate for Payer: OMNI Networks Commercial |
$23.33
|
| Rate for Payer: One Health Plan PPO/POS |
$30.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.66
|
| Rate for Payer: Three Rivers Provider Network All |
$25.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.00
|
| Rate for Payer: Zelis Auto |
$13.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.66
|
| Rate for Payer: Zelis Worker's Compensation |
$9.10
|
|
|
IM ADM INTRANSL/ORAL EA VACCINE
|
Facility
|
IP
|
$33.33
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
7290474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$31.66 |
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: First Health Commercial |
$30.00
|
| Rate for Payer: First Health Workers Compensation |
$12.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.00
|
| Rate for Payer: GEHA Commercial |
$23.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.00
|
| Rate for Payer: Multiplan All |
$30.33
|
| Rate for Payer: OMNI Networks Commercial |
$23.33
|
| Rate for Payer: One Health Plan PPO/POS |
$30.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.66
|
| Rate for Payer: Three Rivers Provider Network All |
$25.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.00
|
| Rate for Payer: Zelis Auto |
$13.33
|
| Rate for Payer: Zelis Worker's Compensation |
$9.10
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
21999425
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
21999425
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
23500067
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
23500067
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
21999426
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
23500068
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| 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 |
$14.67
|
| 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 |
$10.37
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
23500068
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| 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 |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| 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 |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| 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 |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
21999426
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
