|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$232.71
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
8599497
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$221.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$139.63
|
| Rate for Payer: Cash Price |
$139.63
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: First Health Commercial |
$209.44
|
| Rate for Payer: First Health Workers Compensation |
$89.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.44
|
| Rate for Payer: GEHA Commercial |
$186.17
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.44
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$211.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$162.90
|
| Rate for Payer: One Health Plan PPO/POS |
$209.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$76.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$174.53
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$93.08
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.53
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21099497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$76.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21599497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$76.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$232.71
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
7299497
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$221.07 |
| Rate for Payer: Cash Price |
$139.63
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: First Health Commercial |
$209.44
|
| Rate for Payer: First Health Workers Compensation |
$89.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.44
|
| Rate for Payer: GEHA Commercial |
$162.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.44
|
| Rate for Payer: Multiplan All |
$211.77
|
| Rate for Payer: OMNI Networks Commercial |
$162.90
|
| Rate for Payer: One Health Plan PPO/POS |
$209.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.07
|
| Rate for Payer: Three Rivers Provider Network All |
$174.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.42
|
| Rate for Payer: Zelis Auto |
$93.08
|
| Rate for Payer: Zelis Worker's Compensation |
$63.53
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21099497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
25500079
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
AEP NEURODIAGNOSTIC INTERPRET AND REPORT
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
21792653
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$91.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$64.97
|
|
|
AEP NEURODIAGNOSTIC INTERPRET AND REPORT
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
21992653
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$91.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$166.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Worker's Compensation |
$64.97
|
|
|
AEP NEURODIAGNOSTIC INTERPRET AND REPORT
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
21992653
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$91.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$64.97
|
|
|
AEP NEURODIAGNOSTIC INTERPRET AND REPORT
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
21792653
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$91.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$166.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Worker's Compensation |
$64.97
|
|
|
AEP THRESHLD ESTIMAT MLT FREQUENCIES I&R
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
21792652
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
AEP THRESHLD ESTIMAT MLT FREQUENCIES I&R
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
21992652
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
AEP THRESHLD ESTIMAT MLT FREQUENCIES I&R
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
21992652
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
AEP THRESHLD ESTIMAT MLT FREQUENCIES I&R
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
21792652
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
AER BENCH ID EACH NOT URINE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2299062
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$8.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.08
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.74
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.16
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.08
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$6.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.70
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
AER BENCH ID EACH NOT URINE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2299062
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
aerobic bact culture(swab) REF008649
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2247459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
aerobic bact culture(swab) REF008649
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2247459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: GEHA Medicare |
$8.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$9.48
|
| Rate for Payer: Humana Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.62
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.65
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.24
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.45
|
| Rate for Payer: United Healthcare Commercial |
$234.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.62
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Medicare |
$7.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.34
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
aerobic id and susc pure isola REF182261
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2247457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: GEHA Medicare |
$8.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.08
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.74
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.16
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$234.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.08
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Medicare |
$6.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.70
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
aerobic id and susc pure isola REF182261
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2247457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
aerobic id only bacteria REF008664
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2200511
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
aerobic id only bacteria REF008664
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
2200511
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$13.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$8.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.08
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.74
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.16
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.08
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$6.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.70
|
| Rate for Payer: Zelis Worker's Compensation |
$9.29
|
|
|
AEROSOL TX
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
AEROSOL TX
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$386.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$195.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$193.13
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$193.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$212.44
|
| Rate for Payer: Humana Medicare Advantage |
$193.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$324.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$199.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$193.13
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.32
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$230.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$199.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$193.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$386.26
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.27
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$193.13
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$164.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.76
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
afb smear REF008618
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
22990895
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$10.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$5.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$5.93
|
| Rate for Payer: Humana Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.39
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.16
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.78
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$99.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.39
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$4.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.47
|
| Rate for Payer: Zelis Worker's Compensation |
$7.52
|
|
