|
SALINE NASAL SPRAY 0.65%
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
3300812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$15.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
SALINE NASAL SPRAY 0.65%
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 00904386575
|
| Hospital Charge Code |
3300812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
SALINE START ONLY
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
20500112
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
SALINE START ONLY
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
20500112
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| 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 |
$98.07
|
| 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 |
$69.34
|
|
|
salivia drug scrn oral fluid REF 770421
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2299297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
salivia drug scrn oral fluid REF 770421
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2299297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
salmon IgE REF602507
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299191
|
|
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
|
|
|
salmon IgE REF602507
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299191
|
|
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
|
|
|
SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,318.23
|
|
|
Service Code
|
CPT 58720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.16 |
| Max. Negotiated Rate |
$2,318.23 |
| Rate for Payer: First Health Workers Compensation |
$2,318.23
|
| Rate for Payer: Zelis Worker's Compensation |
$1,639.16
|
|
|
SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI
|
Facility
|
OP
|
$2,250.30
|
|
|
Service Code
|
CPT 58720
|
| Hospital Charge Code |
6158720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.58 |
| Max. Negotiated Rate |
$2,137.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,350.18
|
| Rate for Payer: Cash Price |
$1,350.18
|
| Rate for Payer: Cigna Commercial |
$1,912.76
|
| Rate for Payer: First Health Commercial |
$2,025.27
|
| Rate for Payer: First Health Workers Compensation |
$868.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.27
|
| Rate for Payer: GEHA Commercial |
$1,800.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.27
|
| Rate for Payer: Humana ChoiceCare |
$585.08
|
| Rate for Payer: Multiplan All |
$2,047.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,350.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.21
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,980.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$562.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.78
|
| Rate for Payer: Zelis Auto |
$900.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,125.15
|
| Rate for Payer: Zelis Worker's Compensation |
$614.33
|
|
|
SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI
|
Facility
|
IP
|
$2,250.30
|
|
|
Service Code
|
CPT 58720
|
| Hospital Charge Code |
6158720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.33 |
| Max. Negotiated Rate |
$2,137.78 |
| Rate for Payer: Cash Price |
$1,350.18
|
| Rate for Payer: Cigna Commercial |
$1,912.76
|
| Rate for Payer: First Health Commercial |
$2,025.27
|
| Rate for Payer: First Health Workers Compensation |
$868.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.27
|
| Rate for Payer: GEHA Commercial |
$1,575.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.27
|
| Rate for Payer: Multiplan All |
$2,047.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.21
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.78
|
| Rate for Payer: Zelis Auto |
$900.12
|
| Rate for Payer: Zelis Worker's Compensation |
$614.33
|
|
|
SANDOSTATIN LAR DEPOT 30MG INJ
|
Facility
|
IP
|
$19,235.00
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
3302588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,251.15 |
| Max. Negotiated Rate |
$18,273.25 |
| Rate for Payer: Cash Price |
$11,541.00
|
| Rate for Payer: Cigna Commercial |
$16,349.75
|
| Rate for Payer: First Health Commercial |
$17,311.50
|
| Rate for Payer: First Health Workers Compensation |
$7,426.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17,311.50
|
| Rate for Payer: GEHA Commercial |
$13,464.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17,311.50
|
| Rate for Payer: Multiplan All |
$17,503.85
|
| Rate for Payer: OMNI Networks Commercial |
$13,464.50
|
| Rate for Payer: One Health Plan PPO/POS |
$17,311.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18,273.25
|
| Rate for Payer: Three Rivers Provider Network All |
$14,426.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,888.55
|
| Rate for Payer: Zelis Auto |
$7,694.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5,251.15
|
|
|
SANDOSTATIN LAR DEPOT 30MG INJ
|
Facility
|
OP
|
$19,235.00
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
3302588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.94 |
| Max. Negotiated Rate |
$18,273.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$217.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,541.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$217.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$171.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$203.58
|
| Rate for Payer: Cash Price |
$11,541.00
|
| Rate for Payer: Cash Price |
$11,541.00
|
| Rate for Payer: Cigna Commercial |
$16,349.75
|
| Rate for Payer: First Health Commercial |
$17,311.50
|
| Rate for Payer: First Health Workers Compensation |
$7,426.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17,311.50
|
| Rate for Payer: GEHA Commercial |
$223.94
|
| Rate for Payer: GEHA Medicare |
$203.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17,311.50
|
| Rate for Payer: Humana ChoiceCare |
$223.94
|
| Rate for Payer: Humana Medicare Advantage |
$203.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$342.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$175.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$203.58
|
| Rate for Payer: Multiplan All |
$17,503.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$346.09
|
| Rate for Payer: OMNI Networks Commercial |
$13,464.50
|
| Rate for Payer: One Health Plan PPO/POS |
$17,311.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$202.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$175.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$203.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18,273.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$407.16
|
| Rate for Payer: Three Rivers Provider Network All |
$14,426.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$199.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,888.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$203.58
|
| Rate for Payer: Zelis Auto |
$7,694.00
|
| Rate for Payer: Zelis Medicare |
$173.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$244.30
|
| Rate for Payer: Zelis Worker's Compensation |
$5,251.15
|
|
|
SANTYL TOPICAL OINTMENT 30 GM
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
3302817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$277.75 |
| Max. Negotiated Rate |
$1,055.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$944.35
|
| Rate for Payer: First Health Commercial |
$999.90
|
| Rate for Payer: First Health Workers Compensation |
$428.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$999.90
|
| Rate for Payer: GEHA Commercial |
$888.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$999.90
|
| Rate for Payer: Humana ChoiceCare |
$288.86
|
| Rate for Payer: Multiplan All |
$1,011.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$666.60
|
| Rate for Payer: OMNI Networks Commercial |
$777.70
|
| Rate for Payer: One Health Plan PPO/POS |
$999.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,055.45
|
| Rate for Payer: Three Rivers Provider Network All |
$833.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$977.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$277.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,033.23
|
| Rate for Payer: Zelis Auto |
$444.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$555.50
|
| Rate for Payer: Zelis Worker's Compensation |
$303.30
|
|
|
SANTYL TOPICAL OINTMENT 30 GM
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
3302817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$303.30 |
| Max. Negotiated Rate |
$1,055.45 |
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$944.35
|
| Rate for Payer: First Health Commercial |
$999.90
|
| Rate for Payer: First Health Workers Compensation |
$428.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$999.90
|
| Rate for Payer: GEHA Commercial |
$777.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$999.90
|
| Rate for Payer: Multiplan All |
$1,011.01
|
| Rate for Payer: OMNI Networks Commercial |
$777.70
|
| Rate for Payer: One Health Plan PPO/POS |
$999.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,055.45
|
| Rate for Payer: Three Rivers Provider Network All |
$833.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,033.23
|
| Rate for Payer: Zelis Auto |
$444.40
|
| Rate for Payer: Zelis Worker's Compensation |
$303.30
|
|
|
sars cov2 ab, nucleocapsid REF164068
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2200785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$42.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$46.34
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$70.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.13
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$71.62
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$61.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$84.26
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.29
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.13
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$35.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.56
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
sars cov2 ab, nucleocapsid REF164068
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2200785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
sars cov2 antibody, IgA REF164072
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2200640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$42.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$46.34
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$70.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.13
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$71.62
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$61.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$84.26
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.29
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.13
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$35.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.56
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
sars cov2 antibody, IgA REF164072
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2200640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
sars cov2 antibody, Igg REF 831251
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2200641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
sars cov2 antibody, Igg REF 831251
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2200641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$42.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$46.34
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$70.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.13
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$71.62
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$61.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$84.26
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.29
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.13
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$35.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.56
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
SARS CoV 2 igG Ab AGH
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86413
|
| Hospital Charge Code |
2233333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.43
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$55.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$51.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$56.57
|
| Rate for Payer: Humana Medicare Advantage |
$51.43
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.43
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.43
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.86
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.43
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$43.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.72
|
| Rate for Payer: Zelis Worker's Compensation |
$39.40
|
|
|
SARS CoV 2 igG Ab AGH
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86413
|
| Hospital Charge Code |
2233333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$55.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$39.40
|
|
|
SARS CoV 2 NUCLEOCAPSID Abs AGH
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2233334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
|
SARS CoV 2 NUCLEOCAPSID Abs AGH
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
2233334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$66.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$49.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$42.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$46.34
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$70.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.13
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$71.62
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$61.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$84.26
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.29
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.13
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$35.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.56
|
| Rate for Payer: Zelis Worker's Compensation |
$35.07
|
|
