|
RSECT HIP TUM INCL FEMUR
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 27078
|
| Hospital Charge Code |
6127078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,071.25 |
| Max. Negotiated Rate |
$4,070.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,571.00
|
| Rate for Payer: Cash Price |
$2,571.00
|
| Rate for Payer: Cigna Commercial |
$3,642.25
|
| Rate for Payer: First Health Commercial |
$3,856.50
|
| Rate for Payer: First Health Workers Compensation |
$1,654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,856.50
|
| Rate for Payer: GEHA Commercial |
$3,428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,856.50
|
| Rate for Payer: Humana ChoiceCare |
$1,114.10
|
| Rate for Payer: Multiplan All |
$3,899.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,571.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,999.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,856.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,070.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,770.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,071.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,985.05
|
| Rate for Payer: Zelis Auto |
$1,714.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,142.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,169.81
|
|
|
RSV AGH
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
2206438
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.91
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$221.60
|
| Rate for Payer: GEHA Medicare |
$13.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Humana ChoiceCare |
$15.30
|
| Rate for Payer: Humana Medicare Advantage |
$13.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.91
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.65
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.82
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.63
|
| Rate for Payer: United Healthcare Commercial |
$235.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.91
|
| Rate for Payer: Zelis Auto |
$110.80
|
| Rate for Payer: Zelis Medicare |
$11.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.69
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
RSV AGH
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
2206438
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$193.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: Zelis Auto |
$110.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
RSV pcr Cepheid AGH
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
2200774
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$92.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$70.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$77.22
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$117.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$85.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$70.20
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.34
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$98.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$140.40
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$68.80
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$70.20
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$59.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.24
|
| Rate for Payer: Zelis Worker's Compensation |
$65.24
|
|
|
RSV pcr Cepheid AGH
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
2200774
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$92.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$65.24
|
|
|
RSV VACC, PREF A AND PREF B/PF
|
Facility
|
OP
|
$1,287.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
3303227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$1,222.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna Commercial |
$1,093.95
|
| Rate for Payer: First Health Commercial |
$1,158.30
|
| Rate for Payer: First Health Workers Compensation |
$496.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,158.30
|
| Rate for Payer: GEHA Commercial |
$1,029.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,158.30
|
| Rate for Payer: Humana ChoiceCare |
$334.62
|
| Rate for Payer: Multiplan All |
$1,171.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$772.20
|
| Rate for Payer: OMNI Networks Commercial |
$900.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,158.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,222.65
|
| Rate for Payer: Three Rivers Provider Network All |
$965.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,132.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,196.91
|
| Rate for Payer: Zelis Auto |
$514.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$643.50
|
| Rate for Payer: Zelis Worker's Compensation |
$351.35
|
|
|
RSV VACC, PREF A AND PREF B/PF
|
Facility
|
IP
|
$1,287.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
3303227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$351.35 |
| Max. Negotiated Rate |
$1,222.65 |
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna Commercial |
$1,093.95
|
| Rate for Payer: First Health Commercial |
$1,158.30
|
| Rate for Payer: First Health Workers Compensation |
$496.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,158.30
|
| Rate for Payer: GEHA Commercial |
$900.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,158.30
|
| Rate for Payer: Multiplan All |
$1,171.17
|
| Rate for Payer: OMNI Networks Commercial |
$900.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,158.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,222.65
|
| Rate for Payer: Three Rivers Provider Network All |
$965.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,196.91
|
| Rate for Payer: Zelis Auto |
$514.80
|
| Rate for Payer: Zelis Worker's Compensation |
$351.35
|
|
|
RT EDUCATION AND EVALUATION
|
Facility
|
IP
|
$401.71
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4094664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$381.62 |
| Rate for Payer: Cash Price |
$241.03
|
| Rate for Payer: Cigna Commercial |
$341.45
|
| Rate for Payer: First Health Commercial |
$361.54
|
| Rate for Payer: First Health Workers Compensation |
$155.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$361.54
|
| Rate for Payer: GEHA Commercial |
$281.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$361.54
|
| Rate for Payer: Multiplan All |
$365.56
|
| Rate for Payer: OMNI Networks Commercial |
$281.20
|
| Rate for Payer: One Health Plan PPO/POS |
$361.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$381.62
|
| Rate for Payer: Three Rivers Provider Network All |
$301.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$373.59
|
| Rate for Payer: Zelis Auto |
$160.68
|
| Rate for Payer: Zelis Worker's Compensation |
$109.67
|
|
|
RT EDUCATION AND EVALUATION
|
Facility
|
OP
|
$401.71
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4094664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$386.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$241.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$195.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$193.13
|
| Rate for Payer: Cash Price |
$241.03
|
| Rate for Payer: Cash Price |
$241.03
|
| Rate for Payer: Cigna Commercial |
$341.45
|
| Rate for Payer: First Health Commercial |
$361.54
|
| Rate for Payer: First Health Workers Compensation |
$155.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$361.54
|
| Rate for Payer: GEHA Commercial |
$321.37
|
| Rate for Payer: GEHA Medicare |
$193.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$361.54
|
| Rate for Payer: Humana ChoiceCare |
$212.44
|
| Rate for Payer: Humana Medicare Advantage |
$193.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$324.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$199.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$193.13
|
| Rate for Payer: Multiplan All |
$365.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.32
|
| Rate for Payer: OMNI Networks Commercial |
$281.20
|
| Rate for Payer: One Health Plan PPO/POS |
$361.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$230.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$199.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$193.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$381.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$386.26
|
| Rate for Payer: Three Rivers Provider Network All |
$301.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.27
|
| Rate for Payer: United Healthcare Commercial |
$341.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$373.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$193.13
|
| Rate for Payer: Zelis Auto |
$160.68
|
| Rate for Payer: Zelis Medicare |
$164.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.76
|
| Rate for Payer: Zelis Worker's Compensation |
$109.67
|
|
|
rubella abs IgG REF006197
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
2299165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$14.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$15.83
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.39
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.46
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.78
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.39
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$12.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.27
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
rubella abs IgG REF006197
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
2299165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
rubella abs IgM REF096537
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
2247289
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$14.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$15.83
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.39
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.46
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.78
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.39
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$12.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.27
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
rubella abs IgM REF096537
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
2247289
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
russian thistle IgE REF602515
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
russian thistle IgE REF602515
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
saccharomyces cerevisiae ab IgG&IgA
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
22990329
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$19.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$13.73
|
|
|
saccharomyces cerevisiae ab IgG&IgA
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
22990329
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$19.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$12.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.25
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.82
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.50
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.25
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$10.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.70
|
| Rate for Payer: Zelis Worker's Compensation |
$13.73
|
|
|
SACUBITRIL/ VALSARTAN 24-26 MG
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
3302920
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
SACUBITRIL/ VALSARTAN 24-26 MG
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
3302920
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
SALICYLATE (Vitros)
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
2232227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Humana ChoiceCare |
$49.40
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.00
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$167.20
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
SALICYLATE (Vitros)
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
2232227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$133.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
SALINE INF SONOHYSTE
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
2600545
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: First Health Workers Compensation |
$143.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.79
|
|
|
SALINE INF SONOHYSTE
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
2600545
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: First Health Workers Compensation |
$143.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$896.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$101.79
|
|
|
SALINE INJECTION W/ BENZYL ALCOHOL
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 00409196612
|
| Hospital Charge Code |
3300811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
SALINE INJECTION W/ BENZYL ALCOHOL
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 00409196612
|
| Hospital Charge Code |
3300811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
