|
CA IONIZED ARTERIAL
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
4099470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$26.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$13.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$13.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.68
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.26
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.36
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.41
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.68
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$11.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.42
|
| Rate for Payer: Zelis Worker's Compensation |
$18.48
|
|
|
CA IONIZED ARTERIAL
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
4099470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$26.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.48
|
|
|
CALAMINE LOTION
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
3300133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CALAMINE LOTION
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
3300133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CALCITONIN NASAL 200 IU/SPRAY 3.7 ML BOT
|
Facility
|
OP
|
$668.85
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
3303196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$3,553.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,553.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$401.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,553.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,815.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$484.97
|
| Rate for Payer: Cash Price |
$401.31
|
| Rate for Payer: Cash Price |
$401.31
|
| Rate for Payer: Cigna Commercial |
$568.52
|
| Rate for Payer: First Health Commercial |
$601.97
|
| Rate for Payer: First Health Workers Compensation |
$258.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.97
|
| Rate for Payer: GEHA Commercial |
$535.08
|
| Rate for Payer: GEHA Medicare |
$484.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.97
|
| Rate for Payer: Humana ChoiceCare |
$533.47
|
| Rate for Payer: Humana Medicare Advantage |
$484.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$814.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,872.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$484.97
|
| Rate for Payer: Multiplan All |
$608.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$824.45
|
| Rate for Payer: OMNI Networks Commercial |
$468.19
|
| Rate for Payer: One Health Plan PPO/POS |
$601.97
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,316.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,872.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$484.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.41
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$501.64
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,872.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$484.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$622.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$484.97
|
| Rate for Payer: Zelis Auto |
$267.54
|
| Rate for Payer: Zelis Medicare |
$412.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$581.96
|
| Rate for Payer: Zelis Worker's Compensation |
$182.60
|
|
|
CALCITONIN NASAL 200 IU/SPRAY 3.7 ML BOT
|
Facility
|
IP
|
$668.85
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
3303196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$635.41 |
| Rate for Payer: Cash Price |
$401.31
|
| Rate for Payer: Cigna Commercial |
$568.52
|
| Rate for Payer: First Health Commercial |
$601.97
|
| Rate for Payer: First Health Workers Compensation |
$258.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.97
|
| Rate for Payer: GEHA Commercial |
$468.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.97
|
| Rate for Payer: Multiplan All |
$608.65
|
| Rate for Payer: OMNI Networks Commercial |
$468.19
|
| Rate for Payer: One Health Plan PPO/POS |
$601.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.41
|
| Rate for Payer: Three Rivers Provider Network All |
$501.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$622.03
|
| Rate for Payer: Zelis Auto |
$267.54
|
| Rate for Payer: Zelis Worker's Compensation |
$182.60
|
|
|
calcitonin REF004895
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
2200751
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.77 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$26.79
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$46.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$212.00
|
| Rate for Payer: GEHA Medicare |
$26.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Humana ChoiceCare |
$29.47
|
| Rate for Payer: Humana Medicare Advantage |
$26.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$38.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$26.79
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.54
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$38.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$26.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$53.58
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$225.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$26.79
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Medicare |
$22.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.15
|
| Rate for Payer: Zelis Worker's Compensation |
$33.15
|
|
|
calcitonin REF004895
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
2200751
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$46.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$185.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.15
|
|
|
CALCITONIN-SALMON 400 U/ 2 ML INJ
|
Facility
|
IP
|
$3,653.20
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
3303213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$997.32 |
| Max. Negotiated Rate |
$3,470.54 |
| Rate for Payer: Cash Price |
$2,191.92
|
| Rate for Payer: Cigna Commercial |
$3,105.22
|
| Rate for Payer: First Health Commercial |
$3,287.88
|
| Rate for Payer: First Health Workers Compensation |
$1,410.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,287.88
|
| Rate for Payer: GEHA Commercial |
$2,557.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,287.88
|
| Rate for Payer: Multiplan All |
$3,324.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.24
|
| Rate for Payer: One Health Plan PPO/POS |
$3,287.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,470.54
|
| Rate for Payer: Three Rivers Provider Network All |
$2,739.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,397.48
|
| Rate for Payer: Zelis Auto |
$1,461.28
|
| Rate for Payer: Zelis Worker's Compensation |
$997.32
|
|
|
CALCITONIN-SALMON 400 U/ 2 ML INJ
|
Facility
|
OP
|
$3,653.20
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
3303213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$412.22 |
| Max. Negotiated Rate |
$3,553.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,553.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,191.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,553.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,815.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$484.97
|
| Rate for Payer: Cash Price |
$2,191.92
|
| Rate for Payer: Cash Price |
$2,191.92
|
| Rate for Payer: Cigna Commercial |
$3,105.22
|
| Rate for Payer: First Health Commercial |
$3,287.88
|
| Rate for Payer: First Health Workers Compensation |
$1,410.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,287.88
|
| Rate for Payer: GEHA Commercial |
$2,922.56
|
| Rate for Payer: GEHA Medicare |
$484.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,287.88
|
| Rate for Payer: Humana ChoiceCare |
$533.47
|
| Rate for Payer: Humana Medicare Advantage |
$484.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$814.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,872.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$484.97
|
| Rate for Payer: Multiplan All |
$3,324.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$824.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.24
|
| Rate for Payer: One Health Plan PPO/POS |
$3,287.88
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,316.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,872.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$484.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,470.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,739.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,872.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$484.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,397.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$484.97
|
| Rate for Payer: Zelis Auto |
$1,461.28
|
| Rate for Payer: Zelis Medicare |
$412.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$581.96
|
| Rate for Payer: Zelis Worker's Compensation |
$997.32
|
|
|
CALCITRIOL 0.25MCG CAP
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
3300134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CALCITRIOL 0.25MCG CAP
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
3300134
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
calcium 24hr urine w/ crea REF003324
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
22990736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.03
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$10.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$6.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.03
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.25
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.06
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.03
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$5.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.24
|
| Rate for Payer: Zelis Worker's Compensation |
$7.72
|
|
|
calcium 24hr urine w/ crea REF003324
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
22990736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$10.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.72
|
|
|
CALCIUM ACETATE 667 MG CAP
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 00904711961
|
| Hospital Charge Code |
3303105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CALCIUM ACETATE 667 MG CAP
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 00904711961
|
| Hospital Charge Code |
3303105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CALCIUM CARBONATE (ANTACID) 1000 MG
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00135011883
|
| Hospital Charge Code |
3302951
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CALCIUM CARBONATE (ANTACID) 1000 MG
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00135011883
|
| Hospital Charge Code |
3302951
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CALCIUM CARBONATE (ANTACID) 750MG
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00135007425
|
| Hospital Charge Code |
3300135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CALCIUM CARBONATE (ANTACID) 750MG
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00135007425
|
| Hospital Charge Code |
3300135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CALCIUM CHLORIDE INJ 10%
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
3300137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
CALCIUM CHLORIDE INJ 10%
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
3300137
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
calcium/crea ratio urine rando REF134908
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
22990735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$5.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Humana Medicare Advantage |
$5.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.16
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.77
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.32
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.16
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$4.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.19
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
calcium/crea ratio urine rando REF134908
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
22990735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
CALCIUM GLUCONATE 10% INJ.- 1GM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT J0612
|
| Hospital Charge Code |
3300139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
