|
t3 free dialysis lc/ms-ms REF503600
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
2200654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: First Health Commercial |
$225.00
|
| Rate for Payer: First Health Workers Compensation |
$31.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.00
|
| Rate for Payer: GEHA Commercial |
$175.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.00
|
| Rate for Payer: Multiplan All |
$227.50
|
| Rate for Payer: OMNI Networks Commercial |
$175.00
|
| Rate for Payer: One Health Plan PPO/POS |
$225.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$237.50
|
| Rate for Payer: Three Rivers Provider Network All |
$187.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$232.50
|
| Rate for Payer: Zelis Auto |
$100.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.03
|
|
|
t3 triiodothyronine REF002188
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
2200794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$22.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$143.20
|
| Rate for Payer: GEHA Medicare |
$14.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Humana ChoiceCare |
$15.60
|
| Rate for Payer: Humana Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.18
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.11
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.36
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.90
|
| Rate for Payer: United Healthcare Commercial |
$152.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.18
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Medicare |
$12.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.02
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
t3 triiodothyronine REF002188
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
2200794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$22.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$125.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
T3 uptake REF001156
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
2299230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$11.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$96.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$7.89
|
|
|
T3 uptake REF001156
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
2299230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$11.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$7.89
|
|
|
t4 free, dialysis/ ms REF501902
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
2299240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$14.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$126.40
|
| Rate for Payer: GEHA Medicare |
$9.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Humana ChoiceCare |
$9.92
|
| Rate for Payer: Humana Medicare Advantage |
$9.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.02
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.33
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.04
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$134.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.02
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Medicare |
$7.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.82
|
| Rate for Payer: Zelis Worker's Compensation |
$10.36
|
|
|
t4 free, dialysis/ ms REF501902
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
2299240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$14.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$110.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.36
|
|
|
t4 thyroxine REF001149
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
2200793
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$12.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.69
|
|
|
t4 thyroxine REF001149
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
2200793
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$12.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$6.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$7.56
|
| Rate for Payer: Humana Medicare Advantage |
$6.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.87
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.68
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.74
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.73
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.87
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$5.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.24
|
| Rate for Payer: Zelis Worker's Compensation |
$8.69
|
|
|
TA - CURRENT PUMP TRNG
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
21900210
|
|
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
|
|
|
TA - CURRENT PUMP TRNG
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
20500111
|
|
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
|
|
|
TA - CURRENT PUMP TRNG
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
21900210
|
|
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
|
|
|
TA - CURRENT PUMP TRNG
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
20500111
|
|
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
|
|
|
TAMSULOSIN HCL 0.4MG CAP
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300871
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
TAMSULOSIN HCL 0.4MG CAP
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300871
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$25.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$8.32
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.20
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
TA - NEW TO PUMP TRNG
|
Facility
|
OP
|
$305.00
|
|
| Hospital Charge Code |
20500110
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
TA - NEW TO PUMP TRNG
|
Facility
|
IP
|
$305.00
|
|
| Hospital Charge Code |
21900209
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
TA - NEW TO PUMP TRNG
|
Facility
|
OP
|
$305.00
|
|
| Hospital Charge Code |
21900209
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
TA - NEW TO PUMP TRNG
|
Facility
|
IP
|
$305.00
|
|
| Hospital Charge Code |
20500110
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
TANGENTIAL BIOPSY SKIN; EACH SEPARATE/AD
|
Facility
|
IP
|
$441.42
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
6111103
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$419.35 |
| Rate for Payer: Cash Price |
$264.85
|
| Rate for Payer: Cigna Commercial |
$375.21
|
| Rate for Payer: First Health Commercial |
$397.28
|
| Rate for Payer: First Health Workers Compensation |
$170.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.28
|
| Rate for Payer: GEHA Commercial |
$308.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.28
|
| Rate for Payer: Multiplan All |
$401.69
|
| Rate for Payer: OMNI Networks Commercial |
$308.99
|
| Rate for Payer: One Health Plan PPO/POS |
$397.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.35
|
| Rate for Payer: Three Rivers Provider Network All |
$331.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.52
|
| Rate for Payer: Zelis Auto |
$176.57
|
| Rate for Payer: Zelis Worker's Compensation |
$120.51
|
|
|
TANGENTIAL BIOPSY SKIN; EACH SEPARATE/AD
|
Facility
|
OP
|
$441.42
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
6111103
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$419.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$264.85
|
| Rate for Payer: Cash Price |
$264.85
|
| Rate for Payer: Cigna Commercial |
$375.21
|
| Rate for Payer: First Health Commercial |
$397.28
|
| Rate for Payer: First Health Workers Compensation |
$170.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.28
|
| Rate for Payer: GEHA Commercial |
$353.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.28
|
| Rate for Payer: Humana ChoiceCare |
$114.77
|
| Rate for Payer: Multiplan All |
$401.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$264.85
|
| Rate for Payer: OMNI Networks Commercial |
$308.99
|
| Rate for Payer: One Health Plan PPO/POS |
$397.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.35
|
| Rate for Payer: Three Rivers Provider Network All |
$331.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$388.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.52
|
| Rate for Payer: Zelis Auto |
$176.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$220.71
|
| Rate for Payer: Zelis Worker's Compensation |
$120.51
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
20300145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
20300145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
21600215
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
OP
|
$134.82
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
8511116
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$128.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.89
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$114.60
|
| Rate for Payer: First Health Commercial |
$121.34
|
| Rate for Payer: First Health Workers Compensation |
$52.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$121.34
|
| Rate for Payer: GEHA Commercial |
$107.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$121.34
|
| Rate for Payer: Humana ChoiceCare |
$35.05
|
| Rate for Payer: Multiplan All |
$122.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.89
|
| Rate for Payer: OMNI Networks Commercial |
$94.37
|
| Rate for Payer: One Health Plan PPO/POS |
$121.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$128.08
|
| Rate for Payer: Three Rivers Provider Network All |
$101.11
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$118.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$125.38
|
| Rate for Payer: Zelis Auto |
$53.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.41
|
| Rate for Payer: Zelis Worker's Compensation |
$36.81
|
|
