|
VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Facility
|
IP
|
$2,751.60
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
6158262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$751.19 |
| Max. Negotiated Rate |
$2,614.02 |
| Rate for Payer: Cash Price |
$1,650.96
|
| Rate for Payer: Cigna Commercial |
$2,338.86
|
| Rate for Payer: First Health Commercial |
$2,476.44
|
| Rate for Payer: First Health Workers Compensation |
$1,062.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,476.44
|
| Rate for Payer: GEHA Commercial |
$1,926.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,476.44
|
| Rate for Payer: Multiplan All |
$2,503.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,926.12
|
| Rate for Payer: One Health Plan PPO/POS |
$2,476.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,614.02
|
| Rate for Payer: Three Rivers Provider Network All |
$2,063.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,558.99
|
| Rate for Payer: Zelis Auto |
$1,100.64
|
| Rate for Payer: Zelis Worker's Compensation |
$751.19
|
|
|
VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Facility
|
OP
|
$2,751.60
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
6158262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$751.19 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,650.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,650.96
|
| Rate for Payer: Cash Price |
$1,650.96
|
| Rate for Payer: Cigna Commercial |
$2,338.86
|
| Rate for Payer: First Health Commercial |
$2,476.44
|
| Rate for Payer: First Health Workers Compensation |
$1,062.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,476.44
|
| Rate for Payer: GEHA Commercial |
$2,201.28
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,476.44
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$2,503.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,926.12
|
| Rate for Payer: One Health Plan PPO/POS |
$2,476.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,614.02
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$2,063.70
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,558.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$1,100.64
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$751.19
|
|
|
VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RP
|
Facility
|
IP
|
$2,950.32
|
|
|
Service Code
|
CPT 58263
|
| Hospital Charge Code |
6158263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$805.44 |
| Max. Negotiated Rate |
$2,802.80 |
| Rate for Payer: Cash Price |
$1,770.19
|
| Rate for Payer: Cigna Commercial |
$2,507.77
|
| Rate for Payer: First Health Commercial |
$2,655.29
|
| Rate for Payer: First Health Workers Compensation |
$1,139.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,655.29
|
| Rate for Payer: GEHA Commercial |
$2,065.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,655.29
|
| Rate for Payer: Multiplan All |
$2,684.79
|
| Rate for Payer: OMNI Networks Commercial |
$2,065.22
|
| Rate for Payer: One Health Plan PPO/POS |
$2,655.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,802.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,212.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,743.80
|
| Rate for Payer: Zelis Auto |
$1,180.13
|
| Rate for Payer: Zelis Worker's Compensation |
$805.44
|
|
|
VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RP
|
Facility
|
OP
|
$2,950.32
|
|
|
Service Code
|
CPT 58263
|
| Hospital Charge Code |
6158263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$805.44 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,770.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,770.19
|
| Rate for Payer: Cash Price |
$1,770.19
|
| Rate for Payer: Cigna Commercial |
$2,507.77
|
| Rate for Payer: First Health Commercial |
$2,655.29
|
| Rate for Payer: First Health Workers Compensation |
$1,139.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,655.29
|
| Rate for Payer: GEHA Commercial |
$2,360.26
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,655.29
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$2,684.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,065.22
|
| Rate for Payer: One Health Plan PPO/POS |
$2,655.29
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,802.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$2,212.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,743.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$1,180.13
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$805.44
|
|
|
VAG HYSTRCTMY, FOR UTERUS 250 G OR LESS
|
Facility
|
OP
|
$2,487.48
|
|
|
Service Code
|
CPT 58260
|
| Hospital Charge Code |
6158260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$679.08 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,492.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,492.49
|
| Rate for Payer: Cash Price |
$1,492.49
|
| Rate for Payer: Cigna Commercial |
$2,114.36
|
| Rate for Payer: First Health Commercial |
$2,238.73
|
| Rate for Payer: First Health Workers Compensation |
$960.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,238.73
|
| Rate for Payer: GEHA Commercial |
$1,989.98
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,238.73
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$2,263.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,741.24
|
| Rate for Payer: One Health Plan PPO/POS |
$2,238.73
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,363.11
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,865.61
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,313.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$994.99
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$679.08
|
|
|
VAG HYSTRCTMY, FOR UTERUS 250 G OR LESS
|
Facility
|
IP
|
$2,487.48
|
|
|
Service Code
|
CPT 58260
|
| Hospital Charge Code |
6158260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$679.08 |
| Max. Negotiated Rate |
$2,363.11 |
| Rate for Payer: Cash Price |
$1,492.49
|
| Rate for Payer: Cigna Commercial |
$2,114.36
|
| Rate for Payer: First Health Commercial |
$2,238.73
|
| Rate for Payer: First Health Workers Compensation |
$960.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,238.73
|
| Rate for Payer: GEHA Commercial |
$1,741.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,238.73
|
| Rate for Payer: Multiplan All |
$2,263.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,741.24
|
| Rate for Payer: One Health Plan PPO/POS |
$2,238.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,363.11
|
| Rate for Payer: Three Rivers Provider Network All |
$1,865.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,313.36
|
| Rate for Payer: Zelis Auto |
$994.99
|
| Rate for Payer: Zelis Worker's Compensation |
$679.08
|
|
|
VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
8159612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.10 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cigna Commercial |
$2,295.00
|
| Rate for Payer: First Health Commercial |
$2,430.00
|
| Rate for Payer: First Health Workers Compensation |
$1,042.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,430.00
|
| Rate for Payer: GEHA Commercial |
$2,160.00
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,430.00
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$2,457.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,890.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,430.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,565.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,511.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,080.00
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$737.10
|
|
|
VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
8159612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.10 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cigna Commercial |
$2,295.00
|
| Rate for Payer: First Health Commercial |
$2,430.00
|
| Rate for Payer: First Health Workers Compensation |
$1,042.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,430.00
|
| Rate for Payer: GEHA Commercial |
$1,890.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,430.00
|
| Rate for Payer: Multiplan All |
$2,457.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,890.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,430.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,565.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,025.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,511.00
|
| Rate for Payer: Zelis Auto |
$1,080.00
|
| Rate for Payer: Zelis Worker's Compensation |
$737.10
|
|
|
VAGINAL HEMORRHAGE PACKING
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
8157180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$709.65 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$672.30
|
| Rate for Payer: First Health Workers Compensation |
$288.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$672.30
|
| Rate for Payer: GEHA Commercial |
$522.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$672.30
|
| Rate for Payer: Multiplan All |
$679.77
|
| Rate for Payer: OMNI Networks Commercial |
$522.90
|
| Rate for Payer: One Health Plan PPO/POS |
$672.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$709.65
|
| Rate for Payer: Three Rivers Provider Network All |
$560.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$694.71
|
| Rate for Payer: Zelis Auto |
$298.80
|
| Rate for Payer: Zelis Worker's Compensation |
$203.93
|
|
|
VAGINAL HEMORRHAGE PACKING
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
8157180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$709.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$672.30
|
| Rate for Payer: First Health Workers Compensation |
$288.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$672.30
|
| Rate for Payer: GEHA Commercial |
$597.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$672.30
|
| Rate for Payer: Humana ChoiceCare |
$194.22
|
| Rate for Payer: Multiplan All |
$679.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$448.20
|
| Rate for Payer: OMNI Networks Commercial |
$522.90
|
| Rate for Payer: One Health Plan PPO/POS |
$672.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$709.65
|
| Rate for Payer: Three Rivers Provider Network All |
$560.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$694.71
|
| Rate for Payer: Zelis Auto |
$298.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$373.50
|
| Rate for Payer: Zelis Worker's Compensation |
$203.93
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,824.80 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 58262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,824.80 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S), WITH REPAIR OF ENTEROCELE
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 58263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,824.80 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
VAGINECTOMY PARTIAL W/NODES
|
Facility
|
OP
|
$3,613.00
|
|
|
Service Code
|
CPT 57109
|
| Hospital Charge Code |
6157109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$986.35 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,167.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$2,167.80
|
| Rate for Payer: Cash Price |
$2,167.80
|
| Rate for Payer: Cigna Commercial |
$3,071.05
|
| Rate for Payer: First Health Commercial |
$3,251.70
|
| Rate for Payer: First Health Workers Compensation |
$1,394.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,251.70
|
| Rate for Payer: GEHA Commercial |
$2,890.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,251.70
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$3,287.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,529.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,251.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,432.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,709.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,360.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,445.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$986.35
|
|
|
VAGINECTOMY PARTIAL W/NODES
|
Facility
|
IP
|
$3,613.00
|
|
|
Service Code
|
CPT 57109
|
| Hospital Charge Code |
6157109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$986.35 |
| Max. Negotiated Rate |
$3,432.35 |
| Rate for Payer: Cash Price |
$2,167.80
|
| Rate for Payer: Cigna Commercial |
$3,071.05
|
| Rate for Payer: First Health Commercial |
$3,251.70
|
| Rate for Payer: First Health Workers Compensation |
$1,394.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,251.70
|
| Rate for Payer: GEHA Commercial |
$2,529.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,251.70
|
| Rate for Payer: Multiplan All |
$3,287.83
|
| Rate for Payer: OMNI Networks Commercial |
$2,529.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,251.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,432.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,709.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,360.09
|
| Rate for Payer: Zelis Auto |
$1,445.20
|
| Rate for Payer: Zelis Worker's Compensation |
$986.35
|
|
|
VAGINECTOMY W/NODES COMPL
|
Facility
|
IP
|
$3,856.00
|
|
|
Service Code
|
CPT 57112
|
| Hospital Charge Code |
6157112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,052.69 |
| Max. Negotiated Rate |
$3,663.20 |
| Rate for Payer: Cash Price |
$2,313.60
|
| Rate for Payer: Cigna Commercial |
$3,277.60
|
| Rate for Payer: First Health Commercial |
$3,470.40
|
| Rate for Payer: First Health Workers Compensation |
$1,488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,470.40
|
| Rate for Payer: GEHA Commercial |
$2,699.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,470.40
|
| Rate for Payer: Multiplan All |
$3,508.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,470.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,663.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,586.08
|
| Rate for Payer: Zelis Auto |
$1,542.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,052.69
|
|
|
VAGINECTOMY W/NODES COMPL
|
Facility
|
OP
|
$3,856.00
|
|
|
Service Code
|
CPT 57112
|
| Hospital Charge Code |
6157112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$964.00 |
| Max. Negotiated Rate |
$3,663.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,313.60
|
| Rate for Payer: Cash Price |
$2,313.60
|
| Rate for Payer: Cigna Commercial |
$3,277.60
|
| Rate for Payer: First Health Commercial |
$3,470.40
|
| Rate for Payer: First Health Workers Compensation |
$1,488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,470.40
|
| Rate for Payer: GEHA Commercial |
$3,084.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,470.40
|
| Rate for Payer: Humana ChoiceCare |
$1,002.56
|
| Rate for Payer: Multiplan All |
$3,508.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,313.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,470.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,663.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,393.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$964.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,586.08
|
| Rate for Payer: Zelis Auto |
$1,542.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,928.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,052.69
|
|
|
VAGOTOMY & PYLORUS REPAIR
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 43641
|
| Hospital Charge Code |
6143641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.41 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna Commercial |
$2,121.60
|
| Rate for Payer: First Health Commercial |
$2,246.40
|
| Rate for Payer: First Health Workers Compensation |
$963.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,246.40
|
| Rate for Payer: GEHA Commercial |
$1,747.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,246.40
|
| Rate for Payer: Multiplan All |
$2,271.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,321.28
|
| Rate for Payer: Zelis Auto |
$998.40
|
| Rate for Payer: Zelis Worker's Compensation |
$681.41
|
|
|
VAGOTOMY & PYLORUS REPAIR
|
Facility
|
IP
|
$2,482.00
|
|
|
Service Code
|
CPT 43640
|
| Hospital Charge Code |
6143640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.59 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,737.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
|
VAGOTOMY & PYLORUS REPAIR
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
CPT 43641
|
| Hospital Charge Code |
6143641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna Commercial |
$2,121.60
|
| Rate for Payer: First Health Commercial |
$2,246.40
|
| Rate for Payer: First Health Workers Compensation |
$963.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,246.40
|
| Rate for Payer: GEHA Commercial |
$1,996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,246.40
|
| Rate for Payer: Humana ChoiceCare |
$648.96
|
| Rate for Payer: Multiplan All |
$2,271.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,497.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,196.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$624.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,321.28
|
| Rate for Payer: Zelis Auto |
$998.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,248.00
|
| Rate for Payer: Zelis Worker's Compensation |
$681.41
|
|
|
VAGOTOMY & PYLORUS REPAIR
|
Facility
|
OP
|
$2,482.00
|
|
|
Service Code
|
CPT 43640
|
| Hospital Charge Code |
6143640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$620.50 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Humana ChoiceCare |
$645.32
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,489.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,184.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$620.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,241.00
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
|
VALACYCLOVIR 500 MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
3302993
|
|
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
|
|
|
VALACYCLOVIR 500 MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 59746032430
|
| Hospital Charge Code |
3302993
|
|
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
|
|
|
VALACYCLOVIR HCL TAB 1GM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
NDC 00378427693
|
| Hospital Charge Code |
3300932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$22.62
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.20
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$76.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.50
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
VALACYCLOVIR HCL TAB 1GM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
NDC 00378427693
|
| Hospital Charge Code |
3300932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
