|
MUSCLE/TENDON TRANSFER
|
Facility
|
OP
|
$1,534.00
|
|
|
Service Code
|
CPT 24301
|
| Hospital Charge Code |
6124301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.78 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$920.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,227.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,395.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,426.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$613.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$418.78
|
|
|
MUSCLE TRANSFERS
|
Facility
|
OP
|
$2,353.00
|
|
|
Service Code
|
CPT 23397
|
| Hospital Charge Code |
6123397
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$642.37 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,411.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,411.80
|
| Rate for Payer: Cash Price |
$1,411.80
|
| Rate for Payer: Cigna Commercial |
$2,000.05
|
| Rate for Payer: First Health Commercial |
$2,117.70
|
| Rate for Payer: First Health Workers Compensation |
$908.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,117.70
|
| Rate for Payer: GEHA Commercial |
$1,882.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,117.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,141.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,647.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,117.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,235.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,764.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,188.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$941.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$642.37
|
|
|
MUSCLE TRANSFERS
|
Facility
|
IP
|
$2,353.00
|
|
|
Service Code
|
CPT 23397
|
| Hospital Charge Code |
6123397
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$642.37 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Cash Price |
$1,411.80
|
| Rate for Payer: Cigna Commercial |
$2,000.05
|
| Rate for Payer: First Health Commercial |
$2,117.70
|
| Rate for Payer: First Health Workers Compensation |
$908.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,117.70
|
| Rate for Payer: GEHA Commercial |
$1,647.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,117.70
|
| Rate for Payer: Multiplan All |
$2,141.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,647.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,117.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,235.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,764.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,188.29
|
| Rate for Payer: Zelis Auto |
$941.20
|
| Rate for Payer: Zelis Worker's Compensation |
$642.37
|
|
|
MUSCLE TRANSFER SHOULDER/ARM
|
Facility
|
IP
|
$2,645.00
|
|
|
Service Code
|
CPT 23395
|
| Hospital Charge Code |
6123395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$722.09 |
| Max. Negotiated Rate |
$2,512.75 |
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cigna Commercial |
$2,248.25
|
| Rate for Payer: First Health Commercial |
$2,380.50
|
| Rate for Payer: First Health Workers Compensation |
$1,021.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,380.50
|
| Rate for Payer: GEHA Commercial |
$1,851.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,380.50
|
| Rate for Payer: Multiplan All |
$2,406.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,851.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,380.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,512.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,459.85
|
| Rate for Payer: Zelis Auto |
$1,058.00
|
| Rate for Payer: Zelis Worker's Compensation |
$722.09
|
|
|
MUSCLE TRANSFER SHOULDER/ARM
|
Facility
|
OP
|
$2,645.00
|
|
|
Service Code
|
CPT 23395
|
| Hospital Charge Code |
6123395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$722.09 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,587.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cigna Commercial |
$2,248.25
|
| Rate for Payer: First Health Commercial |
$2,380.50
|
| Rate for Payer: First Health Workers Compensation |
$1,021.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,380.50
|
| Rate for Payer: GEHA Commercial |
$2,116.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,380.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,406.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,851.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,380.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,512.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,459.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$1,058.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$722.09
|
|
|
musk ab REF817804
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200413
|
|
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
|
|
|
musk ab REF817804
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200413
|
|
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
|
|
|
MVI (MULTIVITAMIN ) ADULT INJ 10ML
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
3300622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
MVI (MULTIVITAMIN ) ADULT INJ 10ML
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
3300622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.00
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$48.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
mycophenolic acid and metabo REF716795
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
22990805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.49
|
| 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 |
$32.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.05
|
| 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 |
$30.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$18.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$19.86
|
| Rate for Payer: Humana Medicare Advantage |
$18.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.05
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.68
|
| 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 |
$30.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.69
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.05
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$15.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.66
|
| Rate for Payer: Zelis Worker's Compensation |
$21.50
|
|
|
mycophenolic acid and metabo REF716795
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
22990805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| 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 |
$30.40
|
| 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 |
$21.50
|
|
|
mycoplasma genitalium,naa urineREF180025
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
2200597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$40.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$74.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
mycoplasma genitalium,naa urineREF180025
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
2200597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$40.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$85.60
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$90.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
mycoplasma pneumoniae abs IgG REF163741
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.35 |
| 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 |
$20.30
|
| 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 |
$14.35
|
|
|
mycoplasma pneumoniae abs IgG REF163741
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.84
|
| 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 |
$23.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.24
|
| 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 |
$20.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$13.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Humana Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.24
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.51
|
| 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 |
$22.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.48
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.24
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$11.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.89
|
| Rate for Payer: Zelis Worker's Compensation |
$14.35
|
|
|
mycoplasma pneumoniae abs IgM REF163212
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.84
|
| 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 |
$23.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.24
|
| 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 |
$20.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$13.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Humana Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.24
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.51
|
| 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 |
$22.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.48
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.24
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$11.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.89
|
| Rate for Payer: Zelis Worker's Compensation |
$14.35
|
|
|
mycoplasma pneumoniae abs IgM REF163212
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.35 |
| 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 |
$20.30
|
| 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 |
$14.35
|
|
|
mycoplasma pneumoniae dna pcr REF138420
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
2299742
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$206.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
mycoplasma pneumoniae dna pcr REF138420
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
2299742
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$236.00
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$250.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
MYELOGRAM INJECTION
|
Facility
|
IP
|
$1,655.00
|
|
| Hospital Charge Code |
2407206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.81 |
| Max. Negotiated Rate |
$1,572.25 |
| Rate for Payer: Cash Price |
$993.00
|
| Rate for Payer: Cigna Commercial |
$1,406.75
|
| Rate for Payer: First Health Commercial |
$1,489.50
|
| Rate for Payer: First Health Workers Compensation |
$639.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,489.50
|
| Rate for Payer: GEHA Commercial |
$1,158.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,489.50
|
| Rate for Payer: Multiplan All |
$1,506.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,158.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,489.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,572.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,241.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,539.15
|
| Rate for Payer: Zelis Auto |
$662.00
|
| Rate for Payer: Zelis Worker's Compensation |
$451.81
|
|
|
MYELOGRAM INJECTION
|
Facility
|
OP
|
$1,655.00
|
|
| Hospital Charge Code |
2407206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.75 |
| Max. Negotiated Rate |
$1,572.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$993.00
|
| Rate for Payer: Cash Price |
$993.00
|
| Rate for Payer: Cigna Commercial |
$1,406.75
|
| Rate for Payer: First Health Commercial |
$1,489.50
|
| Rate for Payer: First Health Workers Compensation |
$639.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,489.50
|
| Rate for Payer: GEHA Commercial |
$1,324.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,489.50
|
| Rate for Payer: Humana ChoiceCare |
$430.30
|
| Rate for Payer: Multiplan All |
$1,506.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$993.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,158.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,489.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,572.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,241.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,456.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$413.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,539.15
|
| Rate for Payer: Zelis Auto |
$662.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$827.50
|
| Rate for Payer: Zelis Worker's Compensation |
$451.81
|
|
|
myoglobin serum REF010405
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
2299128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.92
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$22.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$12.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$14.21
|
| Rate for Payer: Humana Medicare Advantage |
$12.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.92
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.96
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.84
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.66
|
| Rate for Payer: United Healthcare Commercial |
$213.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.92
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$10.98
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.78
|
|
|
myoglobin serum REF010405
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
2299128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$22.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$15.78
|
|
|
myoglobin urine quant REF003079
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
2233875
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.92
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$22.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$12.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$14.21
|
| Rate for Payer: Humana Medicare Advantage |
$12.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.92
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.96
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.84
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.66
|
| Rate for Payer: United Healthcare Commercial |
$213.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.92
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$10.98
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.78
|
|
|
myoglobin urine quant REF003079
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
2233875
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$22.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$15.78
|
|
