|
PHENYTOIN 50 MG CHEW TAB
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
3303017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
PHENYTOIN 50 MG CHEW TAB
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 60687015625
|
| Hospital Charge Code |
3303017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
phenytoin, free and total REF070706
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
2200742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$26.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$122.40
|
| Rate for Payer: GEHA Medicare |
$13.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Humana ChoiceCare |
$15.14
|
| Rate for Payer: Humana Medicare Advantage |
$13.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.76
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.39
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.52
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.48
|
| Rate for Payer: United Healthcare Commercial |
$130.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.76
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Medicare |
$11.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.51
|
| Rate for Payer: Zelis Worker's Compensation |
$18.47
|
|
|
phenytoin, free and total REF070706
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
2200742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$26.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$107.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.47
|
|
|
phenytoin free (dilantin free) REF070763
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
2200588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$26.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$107.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.47
|
|
|
phenytoin free (dilantin free) REF070763
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
2200588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$26.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$122.40
|
| Rate for Payer: GEHA Medicare |
$13.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Humana ChoiceCare |
$15.14
|
| Rate for Payer: Humana Medicare Advantage |
$13.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.76
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.39
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.52
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.48
|
| Rate for Payer: United Healthcare Commercial |
$130.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.76
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Medicare |
$11.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.51
|
| Rate for Payer: Zelis Worker's Compensation |
$18.47
|
|
|
PHENYTOIN SOD EXTENDED CAP 100MG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 51672411101
|
| Hospital Charge Code |
3300716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
PHENYTOIN SOD EXTENDED CAP 100MG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 51672411101
|
| Hospital Charge Code |
3300716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
PHENYTOIN SODIUM INJ 250MG/5 ML
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J1165
|
| Hospital Charge Code |
3300717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$0.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
PHENYTOIN SODIUM INJ 250MG/5 ML
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J1165
|
| Hospital Charge Code |
3300717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
PHENYTOIN (Vitros)
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
2232226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$72.20 |
| 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 |
$45.60
|
| 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 |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$24.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$13.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| 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 |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.52
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| 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 |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.50
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| 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 |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.25
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$11.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.90
|
| Rate for Payer: Zelis Worker's Compensation |
$17.49
|
|
|
PHENYTOIN (Vitros)
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
2232226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$24.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$17.49
|
|
|
PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDUR
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
24799195
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$307.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$110.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$326.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDUR
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
24799195
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDUR
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
24599195
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDUR
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
24599195
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: First Health Commercial |
$345.60
|
| Rate for Payer: First Health Workers Compensation |
$148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$345.60
|
| Rate for Payer: GEHA Commercial |
$307.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$345.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$349.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$268.80
|
| Rate for Payer: One Health Plan PPO/POS |
$345.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$110.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$364.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$288.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$326.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$357.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$153.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$104.83
|
|
|
PHLEBOTOMY THERAPUTI
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
2209195
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$301.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
PHLEBOTOMY THERAPUTI
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
2209195
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$344.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$110.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$365.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
PHONE E/M PHYS/QHP 11-20 MIN
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8599442
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
PHONE E/M PHYS/QHP 11-20 MIN
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8599442
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
PHONE E/M PHYS/QHP 5-10 MI
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8599441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHONE E/M PHYS/QHP 5-10 MI
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8599441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHOSPHATIDYLERINE AB IGA PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2300022
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| 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 |
$39.12
|
| 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 |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGA PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2200073
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| 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 |
$39.12
|
| 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 |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGA PAN REF
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2300022
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| 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 |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| 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 |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| 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 |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
