|
IMMUNIZATION ADMIN, BY INJ; 1 VACC (SNGL
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8190471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$137.92 |
| 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 |
$78.60
|
| 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 |
$68.96
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$68.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$75.86
|
| Rate for Payer: Humana Medicare Advantage |
$68.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$115.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$68.96
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.23
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| 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 |
$68.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$137.92
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$67.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$68.96
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$58.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.75
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
IMMUNIZATION ADMIN, BY INJ; 1 VACC (SNGL
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8190471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
IMMUNIZATION ADMIN EACH ADD
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
7290472
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$90.25 |
| 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 |
$57.00
|
| 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 |
$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 |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$76.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$24.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.00
|
| 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 |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
IMMUNIZATION ADMIN EACH ADD
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
7290472
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| 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 |
$36.68
|
| 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: 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 |
$25.93
|
|
|
IMMUNIZATION ADMIN, EACH ADDL
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
9390472
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$90.25 |
| 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 |
$57.00
|
| 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 |
$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 |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$76.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$24.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.00
|
| 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 |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
IMMUNIZATION ADMIN, EACH ADDL
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
9390472
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$90.25 |
| 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 |
$36.68
|
| 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 |
$25.93
|
|
|
IMMUNIZATION ADMIN, EACH (STATE)
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8590472
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$14.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
IMMUNIZATION ADMIN, EACH (STATE)
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8590472
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.41 |
| 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 |
$12.48
|
| 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 |
$12.48
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$16.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Humana ChoiceCare |
$5.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.48
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| 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 |
$19.76
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
IMMUNIZATION ADMIN, ORAL/NASAL; 1 VACCIN
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
8190473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: First Health Workers Compensation |
$26.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$48.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Worker's Compensation |
$18.84
|
|
|
IMMUNIZATION ADMIN, ORAL/NASAL; 1 VACCIN
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
8190473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$137.92 |
| 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 |
$41.40
|
| 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 |
$68.96
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: First Health Workers Compensation |
$26.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$55.20
|
| Rate for Payer: GEHA Medicare |
$68.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Humana ChoiceCare |
$75.86
|
| Rate for Payer: Humana Medicare Advantage |
$68.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$115.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$68.96
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.23
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| 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 |
$68.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$137.92
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$67.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$68.96
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Medicare |
$58.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.75
|
| Rate for Payer: Zelis Worker's Compensation |
$18.84
|
|
|
IMMUNIZATION ADMIN (STATE)
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8590471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$14.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
IMMUNIZATION ADMIN (STATE)
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8590471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$137.92 |
| 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 |
$12.48
|
| 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 |
$68.96
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$16.64
|
| Rate for Payer: GEHA Medicare |
$68.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Humana ChoiceCare |
$75.86
|
| Rate for Payer: Humana Medicare Advantage |
$68.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$115.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$68.96
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.23
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| 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 |
$68.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$137.92
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$67.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$68.96
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Medicare |
$58.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.75
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
immunofixation (ife) serum REF 001685
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2236320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$51.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$36.34
|
|
|
immunofixation (ife) serum REF 001685
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2236320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$31.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$51.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$22.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$24.57
|
| Rate for Payer: Humana Medicare Advantage |
$22.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$37.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$22.34
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.98
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$22.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$44.68
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.89
|
| Rate for Payer: United Healthcare Commercial |
$266.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$22.34
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$18.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.81
|
| Rate for Payer: Zelis Worker's Compensation |
$36.34
|
|
|
immunofixation (ife) urine REF123034
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
2299211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: First Health Workers Compensation |
$63.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$193.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: Zelis Auto |
$110.80
|
| Rate for Payer: Zelis Worker's Compensation |
$45.04
|
|
|
immunofixation (ife) urine REF123034
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
2299211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.35
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: First Health Workers Compensation |
$63.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$221.60
|
| Rate for Payer: GEHA Medicare |
$29.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Humana ChoiceCare |
$32.28
|
| Rate for Payer: Humana Medicare Advantage |
$29.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.35
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.90
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$58.70
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.76
|
| Rate for Payer: United Healthcare Commercial |
$235.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.35
|
| Rate for Payer: Zelis Auto |
$110.80
|
| Rate for Payer: Zelis Medicare |
$24.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.22
|
| Rate for Payer: Zelis Worker's Compensation |
$45.04
|
|
|
immunoglobulin g, quant REF001776
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2200662
|
|
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
|
|
|
immunoglobulin g, quant REF001776
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2200662
|
|
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
|
|
|
IMMUNOHISTO AB SLIDE
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
2200051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$697.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$214.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$214.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$170.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$348.56
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$196.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$251.20
|
| Rate for Payer: GEHA Medicare |
$348.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Humana ChoiceCare |
$383.42
|
| Rate for Payer: Humana Medicare Advantage |
$348.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$585.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$173.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$348.56
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$592.55
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$200.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$173.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$348.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$697.12
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$341.59
|
| Rate for Payer: United Healthcare Commercial |
$266.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$348.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$348.56
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Medicare |
$296.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$418.27
|
| Rate for Payer: Zelis Worker's Compensation |
$138.63
|
|
|
IMMUNOHISTO AB SLIDE
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
2200051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$196.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$219.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Worker's Compensation |
$138.63
|
|
|
IMMUNOHISTOCHEM ADD SLIDE
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
2300122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$103.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$251.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Humana ChoiceCare |
$81.64
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$188.40
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$276.32
|
| Rate for Payer: United Healthcare Commercial |
$266.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.09
|
|
|
IMMUNOHISTOCHEM ADD SLIDE
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
2300122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$103.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$219.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Worker's Compensation |
$73.09
|
|
|
IMMUNOHISTOCHEMISTRY
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
2299048
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.19 |
| Max. Negotiated Rate |
$332.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$108.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$108.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$166.04
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$119.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$251.20
|
| Rate for Payer: GEHA Medicare |
$166.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Humana ChoiceCare |
$182.64
|
| Rate for Payer: Humana Medicare Advantage |
$166.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$278.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$87.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$166.04
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$282.27
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$101.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$87.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$166.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$332.08
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$162.72
|
| Rate for Payer: United Healthcare Commercial |
$266.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$166.04
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Medicare |
$141.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$199.25
|
| Rate for Payer: Zelis Worker's Compensation |
$84.19
|
|
|
IMMUNOHISTOCHEMISTRY
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
2299048
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.19 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$266.90
|
| Rate for Payer: First Health Commercial |
$282.60
|
| Rate for Payer: First Health Workers Compensation |
$119.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$282.60
|
| Rate for Payer: GEHA Commercial |
$219.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$282.60
|
| Rate for Payer: Multiplan All |
$285.74
|
| Rate for Payer: OMNI Networks Commercial |
$219.80
|
| Rate for Payer: One Health Plan PPO/POS |
$282.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$298.30
|
| Rate for Payer: Three Rivers Provider Network All |
$235.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.02
|
| Rate for Payer: Zelis Auto |
$125.60
|
| Rate for Payer: Zelis Worker's Compensation |
$84.19
|
|
|
IMOGAM RABIES-HT IM 150 UNIT/ML
|
Facility
|
IP
|
$2,842.00
|
|
|
Service Code
|
NDC 49281019020
|
| Hospital Charge Code |
3302341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$775.87 |
| Max. Negotiated Rate |
$2,699.90 |
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$2,415.70
|
| Rate for Payer: First Health Commercial |
$2,557.80
|
| Rate for Payer: First Health Workers Compensation |
$1,097.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,557.80
|
| Rate for Payer: GEHA Commercial |
$1,989.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,557.80
|
| Rate for Payer: Multiplan All |
$2,586.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,989.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,557.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,699.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,131.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,643.06
|
| Rate for Payer: Zelis Auto |
$1,136.80
|
| Rate for Payer: Zelis Worker's Compensation |
$775.87
|
|
