|
AMYLASE URINE RANDOM
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
2202151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$6.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$7.13
|
| Rate for Payer: Humana Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.48
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.02
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.96
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.48
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$5.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.78
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
AMYLASE URINE RANDOM
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
2202151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 62369
|
| Hospital Charge Code |
6162369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$569.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$284.78
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: GEHA Medicare |
$284.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$313.26
|
| Rate for Payer: Humana Medicare Advantage |
$284.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$478.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$284.78
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$484.13
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$284.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$569.56
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$279.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$284.78
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Medicare |
$242.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$341.74
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 62369
|
| Hospital Charge Code |
6162369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Facility
|
IP
|
$1,271.00
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
6151785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,207.45 |
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cigna Commercial |
$1,080.35
|
| Rate for Payer: First Health Commercial |
$1,143.90
|
| Rate for Payer: First Health Workers Compensation |
$490.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.90
|
| Rate for Payer: GEHA Commercial |
$889.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.90
|
| Rate for Payer: Multiplan All |
$1,156.61
|
| Rate for Payer: OMNI Networks Commercial |
$889.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,207.45
|
| Rate for Payer: Three Rivers Provider Network All |
$953.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.03
|
| Rate for Payer: Zelis Auto |
$508.40
|
| Rate for Payer: Zelis Worker's Compensation |
$346.98
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Facility
|
OP
|
$1,271.00
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
6151785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$1,207.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$762.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cigna Commercial |
$1,080.35
|
| Rate for Payer: First Health Commercial |
$1,143.90
|
| Rate for Payer: First Health Workers Compensation |
$490.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.90
|
| Rate for Payer: GEHA Commercial |
$1,016.80
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.90
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$1,156.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$889.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,207.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$953.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$508.40
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$346.98
|
|
|
ANALYZE SPINE INFUS PUMP
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 62367
|
| Hospital Charge Code |
6162367
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
ANALYZE SPINE INFUS PUMP
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 62367
|
| Hospital Charge Code |
6162367
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$569.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$256.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$256.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$203.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$284.78
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: GEHA Medicare |
$284.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$313.26
|
| Rate for Payer: Humana Medicare Advantage |
$284.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$478.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$207.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$284.78
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$484.13
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$239.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$207.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$284.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$569.56
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$279.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$207.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$284.78
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Medicare |
$242.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$341.74
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 62368
|
| Hospital Charge Code |
6162368
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 62368
|
| Hospital Charge Code |
6162368
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$569.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$256.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$256.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$203.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$284.78
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$284.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$313.26
|
| Rate for Payer: Humana Medicare Advantage |
$284.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$478.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$207.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$284.78
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$484.13
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$239.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$207.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$284.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$569.56
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$279.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$207.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$284.78
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$242.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$341.74
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
ana w/ reflex titer/pattern REF 164947
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
2299081
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$19.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$13.86
|
|
|
ana w/ reflex titer/pattern REF 164947
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
2299081
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$19.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$12.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$13.30
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.09
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.55
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.18
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.85
|
| Rate for Payer: United Healthcare Commercial |
$154.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.09
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$10.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.51
|
| Rate for Payer: Zelis Worker's Compensation |
$13.86
|
|
|
ANCHOR SET GASTROINTESTINAL T-FASTENER
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$437.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
|
|
ANCHOR SET GASTROINTESTINAL T-FASTENER
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
|
|
ANCHOR SUTUREFIX 1.9MM
|
Facility
|
IP
|
$2,182.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.80 |
| Max. Negotiated Rate |
$2,072.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,745.60
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$1,854.70
|
| Rate for Payer: First Health Commercial |
$1,963.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,963.80
|
| Rate for Payer: GEHA Commercial |
$1,527.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,963.80
|
| Rate for Payer: Multiplan All |
$1,985.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,527.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,963.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,072.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,636.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,029.26
|
| Rate for Payer: Zelis Auto |
$872.80
|
|
|
ANCHOR SUTUREFIX 1.9MM
|
Facility
|
OP
|
$2,182.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.50 |
| Max. Negotiated Rate |
$2,072.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$1,854.70
|
| Rate for Payer: First Health Commercial |
$1,963.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,963.80
|
| Rate for Payer: GEHA Commercial |
$1,745.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,963.80
|
| Rate for Payer: Humana ChoiceCare |
$567.32
|
| Rate for Payer: Multiplan All |
$1,985.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,309.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,527.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,963.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,072.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,636.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,920.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$545.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,029.26
|
| Rate for Payer: Zelis Auto |
$872.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,091.00
|
|
|
androstenedione, LC/MS REF004705
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
2200489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$146.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$50.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: GEHA Medicare |
$29.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$32.21
|
| Rate for Payer: Humana Medicare Advantage |
$29.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.28
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.78
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$58.56
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.69
|
| Rate for Payer: United Healthcare Commercial |
$207.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.28
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Medicare |
$24.89
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.14
|
| Rate for Payer: Zelis Worker's Compensation |
$35.67
|
|
|
androstenedione, LC/MS REF004705
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
2200489
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$50.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$35.67
|
|
|
ANES COMPLICATED BY CONTROLLED HYPOTENSI
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 99135
|
| Hospital Charge Code |
9899135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANES COMPLICATED BY CONTROLLED HYPOTENSI
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99135
|
| Hospital Charge Code |
9899135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANES INSR PENI PROS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00938
|
| Hospital Charge Code |
3700938
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANES INSR PENI PROS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00938
|
| Hospital Charge Code |
3700938
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANES LASER VAP PROST
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
3750001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$87.55
|
| Rate for Payer: First Health Commercial |
$92.70
|
| Rate for Payer: First Health Workers Compensation |
$39.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$92.70
|
| Rate for Payer: GEHA Commercial |
$82.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$92.70
|
| Rate for Payer: Humana ChoiceCare |
$26.78
|
| Rate for Payer: Multiplan All |
$93.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.80
|
| Rate for Payer: OMNI Networks Commercial |
$72.10
|
| Rate for Payer: One Health Plan PPO/POS |
$92.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$97.85
|
| Rate for Payer: Three Rivers Provider Network All |
$77.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$90.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$95.79
|
| Rate for Payer: Zelis Auto |
$41.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.50
|
| Rate for Payer: Zelis Worker's Compensation |
$28.12
|
|
|
ANES LASER VAP PROST
|
Facility
|
IP
|
$103.00
|
|
| Hospital Charge Code |
3750001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$87.55
|
| Rate for Payer: First Health Commercial |
$92.70
|
| Rate for Payer: First Health Workers Compensation |
$39.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$92.70
|
| Rate for Payer: GEHA Commercial |
$72.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$92.70
|
| Rate for Payer: Multiplan All |
$93.73
|
| Rate for Payer: OMNI Networks Commercial |
$72.10
|
| Rate for Payer: One Health Plan PPO/POS |
$92.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$97.85
|
| Rate for Payer: Three Rivers Provider Network All |
$77.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$95.79
|
| Rate for Payer: Zelis Auto |
$41.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.12
|
|
|
ANES OTOSCOPY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00124
|
| Hospital Charge Code |
3700124
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
