|
anti centromer REF 520065
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2232296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
antichromatin abs REF 012580
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2299395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
antichromatin abs REF 012580
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2299395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
ANTICOAGULANT MGMT FOR PT TAKING WARFARI
|
Facility
|
OP
|
$362.76
|
|
|
Service Code
|
CPT 93793
|
| Hospital Charge Code |
8693793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.69 |
| Max. Negotiated Rate |
$344.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.66
|
| Rate for Payer: Cash Price |
$217.66
|
| Rate for Payer: Cigna Commercial |
$308.35
|
| Rate for Payer: First Health Commercial |
$326.48
|
| Rate for Payer: First Health Workers Compensation |
$140.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.48
|
| Rate for Payer: GEHA Commercial |
$290.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.48
|
| Rate for Payer: Humana ChoiceCare |
$94.32
|
| Rate for Payer: Multiplan All |
$330.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.66
|
| Rate for Payer: OMNI Networks Commercial |
$253.93
|
| Rate for Payer: One Health Plan PPO/POS |
$326.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.62
|
| Rate for Payer: Three Rivers Provider Network All |
$272.07
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$319.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.37
|
| Rate for Payer: Zelis Auto |
$145.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.38
|
| Rate for Payer: Zelis Worker's Compensation |
$99.03
|
|
|
ANTICOAGULANT MGMT FOR PT TAKING WARFARI
|
Facility
|
IP
|
$362.76
|
|
|
Service Code
|
CPT 93793
|
| Hospital Charge Code |
8693793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$344.62 |
| Rate for Payer: Cash Price |
$217.66
|
| Rate for Payer: Cigna Commercial |
$308.35
|
| Rate for Payer: First Health Commercial |
$326.48
|
| Rate for Payer: First Health Workers Compensation |
$140.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.48
|
| Rate for Payer: GEHA Commercial |
$253.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.48
|
| Rate for Payer: Multiplan All |
$330.11
|
| Rate for Payer: OMNI Networks Commercial |
$253.93
|
| Rate for Payer: One Health Plan PPO/POS |
$326.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.62
|
| Rate for Payer: Three Rivers Provider Network All |
$272.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.37
|
| Rate for Payer: Zelis Auto |
$145.10
|
| Rate for Payer: Zelis Worker's Compensation |
$99.03
|
|
|
antidiuretic hormone profileREF 046557
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
2200746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$11.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$6.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$7.27
|
| Rate for Payer: Humana Medicare Advantage |
$6.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.61
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.24
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.22
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.48
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.61
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$5.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.93
|
| Rate for Payer: Zelis Worker's Compensation |
$8.22
|
|
|
antidiuretic hormone profileREF 046557
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
2200746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$11.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.22
|
|
|
anti-dnase b(strep) abs REF096289
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
2299820
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$27.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$13.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$14.57
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.25
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.52
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.50
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.25
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$11.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.90
|
| Rate for Payer: Zelis Worker's Compensation |
$19.16
|
|
|
anti-dnase b(strep) abs REF096289
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
2299820
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$27.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.16
|
|
|
anti ds dna abs REF096339
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
2299396
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$27.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.64
|
|
|
anti ds dna abs REF096339
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
2299396
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$27.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$13.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$15.11
|
| Rate for Payer: Humana Medicare Advantage |
$13.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.74
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.36
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.48
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.74
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$11.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.49
|
| Rate for Payer: Zelis Worker's Compensation |
$19.64
|
|
|
anti-ena REF006338
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200745
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
anti-ena REF006338
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2200745
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
anti gad abs REF500611
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
2200430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$23.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$25.93
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.57
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.07
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$47.14
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.57
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$20.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.28
|
| Rate for Payer: Zelis Worker's Compensation |
$22.04
|
|
|
anti gad abs REF500611
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
2200430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.04
|
|
|
antiglumerular basement mem REF163050
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
antiglumerular basement mem REF163050
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
anti hu antibodies REF808988
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
2299551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
anti hu antibodies REF808988
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
2299551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
anti mi 2 ab REF520000
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
anti mi 2 ab REF520000
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
anti-mog (anti-myelin olig gly)REF505310
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200719
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
anti-mog (anti-myelin olig gly)REF505310
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200719
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
anti mullerian hormone REF500183
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
2299705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.93
|
| 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 |
$57.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$38.62
|
| 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 |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$38.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$42.48
|
| Rate for Payer: Humana Medicare Advantage |
$38.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$64.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$38.62
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.65
|
| 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 |
$54.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$38.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$77.24
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$37.85
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$38.62
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$32.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.34
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
anti mullerian hormone REF500183
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
2299705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$236.55 |
| 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 |
$96.14
|
| 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 |
$67.98
|
|
