|
alkaline phosphatase REF001107
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
2204076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$70.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
alkaline phosphatase REF001107
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
2204076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
ALKALINE PHOSPHATASE (Vitros)
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
2232199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
ALKALINE PHOSPHATASE (Vitros)
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
2232199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$70.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
ALKA SELTZER GOLD TABS
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 16500056675
|
| Hospital Charge Code |
3302004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ALKA SELTZER GOLD TABS
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 16500056675
|
| Hospital Charge Code |
3302004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
alk phos bone spfc REF513002
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
22990341
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
alk phos bone spfc REF513002
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
22990341
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
alk phos iso REF001612
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
2299250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$25.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$14.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$16.26
|
| Rate for Payer: Humana Medicare Advantage |
$14.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.78
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.13
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.56
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.48
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.78
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$12.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.74
|
| Rate for Payer: Zelis Worker's Compensation |
$18.35
|
|
|
alk phos iso REF001612
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
2299250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$25.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.35
|
|
|
allergen profile-nutREF604764
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200731
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
allergen profile-nutREF604764
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200731
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
ALLERGY MULTI INJECTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
23595117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY MULTI INJECTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
23595117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$21.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
OP
|
$46.14
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
7295117
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$27.68
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cigna Commercial |
$39.22
|
| Rate for Payer: First Health Commercial |
$41.53
|
| Rate for Payer: First Health Workers Compensation |
$17.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.53
|
| Rate for Payer: GEHA Commercial |
$36.91
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.53
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$41.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$32.30
|
| Rate for Payer: One Health Plan PPO/POS |
$41.53
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$34.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$18.46
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$12.60
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
21595117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$21.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
21600046
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$21.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
9395117
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$21.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
8595117
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
25500046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$21.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
25500046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
21600046
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
21595117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
8595117
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$87.62 |
| 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 |
$21.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| 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 |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ALLERGY-MULTI-INJECTION
|
Facility
|
IP
|
$46.14
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
7295117
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cigna Commercial |
$39.22
|
| Rate for Payer: First Health Commercial |
$41.53
|
| Rate for Payer: First Health Workers Compensation |
$17.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.53
|
| Rate for Payer: GEHA Commercial |
$32.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.53
|
| Rate for Payer: Multiplan All |
$41.99
|
| Rate for Payer: OMNI Networks Commercial |
$32.30
|
| Rate for Payer: One Health Plan PPO/POS |
$41.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.83
|
| Rate for Payer: Three Rivers Provider Network All |
$34.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.91
|
| Rate for Payer: Zelis Auto |
$18.46
|
| Rate for Payer: Zelis Worker's Compensation |
$12.60
|
|
