|
THYROID, DESICCATED 15 MG TAB
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 00456045701
|
| Hospital Charge Code |
3302984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
THYROID, DESICCATED 15 MG TAB
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00456045701
|
| Hospital Charge Code |
3302984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
THYROID, DESICCATED 60 MG TAB
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00456045901
|
| Hospital Charge Code |
3302985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
THYROID, DESICCATED 60 MG TAB
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00456045901
|
| Hospital Charge Code |
3302985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
thyroid peroxidase abs tpo REF006676
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
2246070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$28.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$101.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.81
|
|
|
thyroid peroxidase abs tpo REF006676
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
2246070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$28.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$116.00
|
| Rate for Payer: GEHA Medicare |
$14.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Humana ChoiceCare |
$16.00
|
| Rate for Payer: Humana Medicare Advantage |
$14.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.55
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.73
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.10
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.26
|
| Rate for Payer: United Healthcare Commercial |
$123.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.55
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Medicare |
$12.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.46
|
| Rate for Payer: Zelis Worker's Compensation |
$19.81
|
|
|
thyroid stimulating immuno REF140749
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
2299305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$89.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$50.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Humana ChoiceCare |
$55.95
|
| Rate for Payer: Humana Medicare Advantage |
$50.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$85.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$50.86
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.46
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$101.72
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.84
|
| Rate for Payer: United Healthcare Commercial |
$340.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$50.86
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$43.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.03
|
| Rate for Payer: Zelis Worker's Compensation |
$63.24
|
|
|
thyroid stimulating immuno REF140749
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
2299305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$89.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$63.24
|
|
|
thyropin binding inhibi immno REF010314
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
22990940
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
thyropin binding inhibi immno REF010314
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
22990940
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
thyroxine-binding globulin REF001735
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
2200778
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$23.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.93
|
|
|
thyroxine-binding globulin REF001735
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
2200778
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$23.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$14.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$16.26
|
| Rate for Payer: Humana Medicare Advantage |
$14.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.78
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.13
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.56
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.48
|
| Rate for Payer: United Healthcare Commercial |
$153.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.78
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$12.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.74
|
| Rate for Payer: Zelis Worker's Compensation |
$16.93
|
|
|
TIAGABINE HCL TAB 12MG
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
NDC 00093807256
|
| Hospital Charge Code |
3300891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
TIAGABINE HCL TAB 12MG
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
NDC 00093807256
|
| Hospital Charge Code |
3300891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
TIBC, direct (Vitros)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
2232284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$15.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$8.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$9.61
|
| Rate for Payer: Humana Medicare Advantage |
$8.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.74
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.86
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.48
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$42.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.74
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$7.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.49
|
| Rate for Payer: Zelis Worker's Compensation |
$10.72
|
|
|
TIBC, direct (Vitros)
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
2232284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$15.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.72
|
|
|
tibc iron REF 100333
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
2232303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$15.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.72
|
|
|
tibc iron REF 100333
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
2232303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$15.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$8.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$9.61
|
| Rate for Payer: Humana Medicare Advantage |
$8.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.74
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.86
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.48
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$42.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.74
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$7.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.49
|
| Rate for Payer: Zelis Worker's Compensation |
$10.72
|
|
|
TIBIAL AUGMENT HALF BLOCK
|
Facility
|
IP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.60 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,887.20
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,526.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
|
|
TIBIAL AUGMENT HALF BLOCK
|
Facility
|
OP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.25 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Humana ChoiceCare |
$938.34
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,165.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,175.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,804.50
|
|
|
TIBIAL BASEPLATE STRYKER
|
Facility
|
OP
|
$4,406.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.50 |
| Max. Negotiated Rate |
$4,185.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,643.60
|
| Rate for Payer: Cash Price |
$2,643.60
|
| Rate for Payer: Cash Price |
$2,643.60
|
| Rate for Payer: Cigna Commercial |
$3,745.10
|
| Rate for Payer: First Health Commercial |
$3,965.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,965.40
|
| Rate for Payer: GEHA Commercial |
$3,524.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,965.40
|
| Rate for Payer: Humana ChoiceCare |
$1,145.56
|
| Rate for Payer: Multiplan All |
$4,009.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,643.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,084.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,965.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,185.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,877.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,101.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,097.58
|
| Rate for Payer: Zelis Auto |
$1,762.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,203.00
|
|
|
TIBIAL BASEPLATE STRYKER
|
Facility
|
IP
|
$4,406.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,762.40 |
| Max. Negotiated Rate |
$4,185.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,524.80
|
| Rate for Payer: Cash Price |
$2,643.60
|
| Rate for Payer: Cash Price |
$2,643.60
|
| Rate for Payer: Cigna Commercial |
$3,745.10
|
| Rate for Payer: First Health Commercial |
$3,965.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,965.40
|
| Rate for Payer: GEHA Commercial |
$3,084.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,965.40
|
| Rate for Payer: Multiplan All |
$4,009.46
|
| Rate for Payer: OMNI Networks Commercial |
$3,084.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,965.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,185.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,097.58
|
| Rate for Payer: Zelis Auto |
$1,762.40
|
|
|
TIBIAL DISTAL AUGMENT
|
Facility
|
IP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.60 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,887.20
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,526.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
|
|
TIBIAL DISTAL AUGMENT
|
Facility
|
OP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.25 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Humana ChoiceCare |
$938.34
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,165.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,175.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,804.50
|
|
|
TIBIAL DISTAL AUGMENT
|
Facility
|
OP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.25 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Humana ChoiceCare |
$938.34
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,165.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,175.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,804.50
|
|
