|
THROMBIN FOR SOLN KIT 20,000 UNIT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
NDC 60793021720
|
| Hospital Charge Code |
3300890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$550.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
|
THROMBIN SPRAY 5,000IU
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
3301724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.50 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$276.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Humana ChoiceCare |
$89.96
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.60
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$304.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$173.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
THROMBIN SPRAY 5,000IU
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
3301724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: First Health Commercial |
$311.40
|
| Rate for Payer: First Health Workers Compensation |
$133.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$311.40
|
| Rate for Payer: GEHA Commercial |
$242.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$311.40
|
| Rate for Payer: Multiplan All |
$314.86
|
| Rate for Payer: OMNI Networks Commercial |
$242.20
|
| Rate for Payer: One Health Plan PPO/POS |
$311.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$328.70
|
| Rate for Payer: Three Rivers Provider Network All |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$321.78
|
| Rate for Payer: Zelis Auto |
$138.40
|
| Rate for Payer: Zelis Worker's Compensation |
$94.46
|
|
|
THROMBOLYSIS ART INFUSION ICRA RS&I INIT
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
6137211
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
THROMBOLYSIS ART INFUSION ICRA RS&I INIT
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
6137211
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,114.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,114.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$882.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$900.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,040.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$900.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$900.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
THROMBOLYSIS ART INFUSION ICRA RS&I INIT
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
1000046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,315.04 |
| Max. Negotiated Rate |
$8,056.00 |
| Rate for Payer: Cash Price |
$5,088.00
|
| Rate for Payer: Cigna Commercial |
$7,208.00
|
| Rate for Payer: First Health Commercial |
$7,632.00
|
| Rate for Payer: First Health Workers Compensation |
$3,274.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,632.00
|
| Rate for Payer: GEHA Commercial |
$5,936.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,632.00
|
| Rate for Payer: Multiplan All |
$7,716.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,936.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,632.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,056.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,360.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,886.40
|
| Rate for Payer: Zelis Auto |
$3,392.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,315.04
|
|
|
THROMBOLYSIS ART/VEN INFSN W/IMAGE SUBSQ
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
6137213
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
THROMBOLYSIS ART/VEN INFSN W/IMAGE SUBSQ
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
6137213
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,487.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,487.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,970.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,010.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,321.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,010.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,010.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
THROMBOLYSIS ART/VEN INFSN W/IMAGE SUBSQ
|
Facility
|
IP
|
$6,801.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
1000047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,856.67 |
| Max. Negotiated Rate |
$6,460.95 |
| Rate for Payer: Cash Price |
$4,080.60
|
| Rate for Payer: Cigna Commercial |
$5,780.85
|
| Rate for Payer: First Health Commercial |
$6,120.90
|
| Rate for Payer: First Health Workers Compensation |
$2,625.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,120.90
|
| Rate for Payer: GEHA Commercial |
$4,760.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,120.90
|
| Rate for Payer: Multiplan All |
$6,188.91
|
| Rate for Payer: OMNI Networks Commercial |
$4,760.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,120.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,460.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,100.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,324.93
|
| Rate for Payer: Zelis Auto |
$2,720.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,856.67
|
|
|
THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
8137195
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.86 |
| Max. Negotiated Rate |
$1,235.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$780.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$1,105.85
|
| Rate for Payer: First Health Commercial |
$1,170.90
|
| Rate for Payer: First Health Workers Compensation |
$502.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.90
|
| Rate for Payer: GEHA Commercial |
$1,040.80
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.90
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$1,183.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$910.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$975.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$520.40
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$355.17
|
|
|
THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
8137195
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.17 |
| Max. Negotiated Rate |
$1,235.95 |
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$1,105.85
|
| Rate for Payer: First Health Commercial |
$1,170.90
|
| Rate for Payer: First Health Workers Compensation |
$502.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.90
|
| Rate for Payer: GEHA Commercial |
$910.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.90
|
| Rate for Payer: Multiplan All |
$1,183.91
|
| Rate for Payer: OMNI Networks Commercial |
$910.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.95
|
| Rate for Payer: Three Rivers Provider Network All |
$975.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.93
|
| Rate for Payer: Zelis Auto |
$520.40
|
| Rate for Payer: Zelis Worker's Compensation |
$355.17
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
6137212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,114.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,114.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$882.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$795.60
|
| Rate for Payer: First Health Commercial |
$842.40
|
| Rate for Payer: First Health Workers Compensation |
$361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$842.40
|
| Rate for Payer: GEHA Commercial |
$748.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$842.40
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$900.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$851.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$655.20
|
| Rate for Payer: One Health Plan PPO/POS |
$842.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,040.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$900.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$889.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$702.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$900.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$870.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$374.40
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$255.53
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
6137212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$795.60
|
| Rate for Payer: First Health Commercial |
$842.40
|
| Rate for Payer: First Health Workers Compensation |
$361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$842.40
|
| Rate for Payer: GEHA Commercial |
$655.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$842.40
|
| Rate for Payer: Multiplan All |
$851.76
|
| Rate for Payer: OMNI Networks Commercial |
$655.20
|
| Rate for Payer: One Health Plan PPO/POS |
$842.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$889.20
|
| Rate for Payer: Three Rivers Provider Network All |
$702.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$870.48
|
| Rate for Payer: Zelis Auto |
$374.40
|
| Rate for Payer: Zelis Worker's Compensation |
$255.53
|
|
|
THUMB FUSION WITH GRAFT
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
CPT 26842
|
| Hospital Charge Code |
6126842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.06 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$934.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cigna Commercial |
$1,323.45
|
| Rate for Payer: First Health Commercial |
$1,401.30
|
| Rate for Payer: First Health Workers Compensation |
$601.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,401.30
|
| Rate for Payer: GEHA Commercial |
$1,245.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,401.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,416.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,401.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,479.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$622.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$425.06
|
|
|
THUMB FUSION WITH GRAFT
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 26842
|
| Hospital Charge Code |
6126842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.06 |
| Max. Negotiated Rate |
$1,479.15 |
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cigna Commercial |
$1,323.45
|
| Rate for Payer: First Health Commercial |
$1,401.30
|
| Rate for Payer: First Health Workers Compensation |
$601.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,401.30
|
| Rate for Payer: GEHA Commercial |
$1,089.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,401.30
|
| Rate for Payer: Multiplan All |
$1,416.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,401.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,479.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.01
|
| Rate for Payer: Zelis Auto |
$622.80
|
| Rate for Payer: Zelis Worker's Compensation |
$425.06
|
|
|
THUMB SPICA WRIST BRACE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8800024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
|
|
THUMB SPICA WRIST BRACE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8800024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
THUMB SPICA WRIST BRACE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8230082
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
THUMB SPICA WRIST BRACE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8230082
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
|
|
THUMB TENDON TRANSFER
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 26510
|
| Hospital Charge Code |
6126510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.77 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: First Health Workers Compensation |
$449.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$317.77
|
|
|
THUMB TENDON TRANSFER
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 26510
|
| Hospital Charge Code |
6126510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.77 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: First Health Workers Compensation |
$449.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Worker's Compensation |
$317.77
|
|
|
thyroglobulin antibody only REF006685
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
2200042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$17.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.72
|
|
|
thyroglobulin antibody only REF006685
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
2200042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$17.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$9.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$10.68
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.71
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.51
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.42
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$130.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.71
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$8.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.65
|
| Rate for Payer: Zelis Worker's Compensation |
$12.72
|
|
|
thyroglobulin by lcms REF070125
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2200629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$24.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: GEHA Medicare |
$16.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$17.67
|
| Rate for Payer: Humana Medicare Advantage |
$16.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.06
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.12
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.74
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.06
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Medicare |
$13.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.27
|
| Rate for Payer: Zelis Worker's Compensation |
$17.63
|
|
|
thyroglobulin by lcms REF070125
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2200629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$24.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$17.63
|
|
