|
QUETIAPINE FUM ER 200 MG TAB
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
330294
|
|
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
|
|
|
QUETIAPINE IR 100 MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
3302963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
QUETIAPINE IR 100 MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
3302963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
quetiapine serum/plasma REF808404
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
2299775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.12 |
| 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 |
$31.28
|
| 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 |
$22.12
|
|
|
quetiapine serum/plasma REF808404
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
2299775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.55
|
| 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 |
$33.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.64
|
| 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 |
$31.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$18.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$20.50
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.64
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.69
|
| 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 |
$31.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.28
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$213.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.64
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$15.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.37
|
| Rate for Payer: Zelis Worker's Compensation |
$22.12
|
|
|
QUINAPRIL HCL 20 MG TAB
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 31722026990
|
| Hospital Charge Code |
3300782
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
QUINAPRIL HCL 20 MG TAB
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 31722026990
|
| Hospital Charge Code |
3300782
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
rabies ab REF083885
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
2200415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$34.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: GEHA Medicare |
$16.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$18.60
|
| Rate for Payer: Humana Medicare Advantage |
$16.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.91
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.75
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.82
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.57
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.91
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$14.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.29
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
rabies ab REF083885
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
2200415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$34.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
RABIES VACCINE, IM
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
8590675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$627.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$356.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$356.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$282.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$345.05
|
| Rate for Payer: GEHA Medicare |
$313.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Humana ChoiceCare |
$345.05
|
| Rate for Payer: Humana Medicare Advantage |
$313.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$526.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$287.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$313.68
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$533.26
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$332.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$287.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$313.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$627.36
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$307.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$287.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$313.68
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Medicare |
$266.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$376.42
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
RABIES VACCINE, IM
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
8590675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$329.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
RACEPINEPHRINE 2.25% NEB
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
3300784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
RACEPINEPHRINE 2.25% NEB
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
3300784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKU 6/>VW
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
8230063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$119.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$561.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$84.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKU 6/>VW
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
8230063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$119.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKU 6/>VW
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
2406515
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$803.25
|
| Rate for Payer: First Health Commercial |
$850.50
|
| Rate for Payer: First Health Workers Compensation |
$119.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$850.50
|
| Rate for Payer: GEHA Commercial |
$661.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$850.50
|
| Rate for Payer: Multiplan All |
$859.95
|
| Rate for Payer: OMNI Networks Commercial |
$661.50
|
| Rate for Payer: One Health Plan PPO/POS |
$850.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$897.75
|
| Rate for Payer: Three Rivers Provider Network All |
$708.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$878.85
|
| Rate for Payer: Zelis Auto |
$378.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKU 6/>VW
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
2406515
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$567.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$803.25
|
| Rate for Payer: First Health Commercial |
$850.50
|
| Rate for Payer: First Health Workers Compensation |
$119.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$850.50
|
| Rate for Payer: GEHA Commercial |
$756.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$850.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$859.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$661.50
|
| Rate for Payer: One Health Plan PPO/POS |
$850.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$897.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$708.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$803.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$878.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$378.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$84.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKUL 2/3V
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
8230061
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$86.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$61.45
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKUL 2/3V
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
8230061
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$86.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$301.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$61.45
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKUL 4/5V
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
8230062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$97.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$561.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$68.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKUL 4/5V
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
2406514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: First Health Commercial |
$811.80
|
| Rate for Payer: First Health Workers Compensation |
$97.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$811.80
|
| Rate for Payer: GEHA Commercial |
$721.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$811.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$820.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$631.40
|
| Rate for Payer: One Health Plan PPO/POS |
$811.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$856.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$676.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$766.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$838.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$360.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$68.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKUL 4/5V
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
8230062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$97.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$68.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKUL 4/5V
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
2406514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: First Health Commercial |
$811.80
|
| Rate for Payer: First Health Workers Compensation |
$97.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$811.80
|
| Rate for Payer: GEHA Commercial |
$631.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$811.80
|
| Rate for Payer: Multiplan All |
$820.82
|
| Rate for Payer: OMNI Networks Commercial |
$631.40
|
| Rate for Payer: One Health Plan PPO/POS |
$811.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$856.90
|
| Rate for Payer: Three Rivers Provider Network All |
$676.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$838.86
|
| Rate for Payer: Zelis Auto |
$360.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.81
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKULL 1VW
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
8230060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$52.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$37.18
|
|
|
RADEX ENTIR THRC L/C/SAC SPI W/SKULL 1VW
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
8230060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$52.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.18
|
|
