|
VECURONIUM BROMIDE 10 MG/10 ML
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
NDC 00703291403
|
| Hospital Charge Code |
3303008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$42.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Humana ChoiceCare |
$13.78
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.80
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.50
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
VECURONIUM BROMIDE 10 MG/10 ML
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
NDC 00703291403
|
| Hospital Charge Code |
3303008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$37.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
VEDOLIZUMAB 300 MG/NS 250 ML IVPB PT-OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3303172
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
VEDOLIZUMAB 300 MG/NS 250 ML IVPB PT-OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3303172
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
VEDOLIZUMAB 300 MG VIAL INJ PT-OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J3380
|
| Hospital Charge Code |
3303171
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$42.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.31
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$23.44
|
| Rate for Payer: GEHA Medicare |
$21.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$23.44
|
| Rate for Payer: Humana Medicare Advantage |
$21.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.31
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.23
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42.62
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.31
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$18.11
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.57
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
VEDOLIZUMAB 300 MG VIAL INJ PT-OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J3380
|
| Hospital Charge Code |
3303171
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
VELTASSA ORAL SUSP 8.4 GM
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
NDC 53436008430
|
| Hospital Charge Code |
3302832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
VELTASSA ORAL SUSP 8.4 GM
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
NDC 53436008430
|
| Hospital Charge Code |
3302832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
VENIPUNCTURE , 1 YR.
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 36420
|
| Hospital Charge Code |
6136420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
VENIPUNCTURE , 1 YR.
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 36420
|
| Hospital Charge Code |
6136420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
VENIPUNCTURE 1 YR OR OLDER
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
6136425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$106.25
|
| Rate for Payer: First Health Commercial |
$112.50
|
| Rate for Payer: First Health Workers Compensation |
$48.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$112.50
|
| Rate for Payer: GEHA Commercial |
$87.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$112.50
|
| Rate for Payer: Multiplan All |
$113.75
|
| Rate for Payer: OMNI Networks Commercial |
$87.50
|
| Rate for Payer: One Health Plan PPO/POS |
$112.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$118.75
|
| Rate for Payer: Three Rivers Provider Network All |
$93.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$116.25
|
| Rate for Payer: Zelis Auto |
$50.00
|
| Rate for Payer: Zelis Worker's Compensation |
$34.12
|
|
|
VENIPUNCTURE 1 YR OR OLDER
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
6136425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$106.25
|
| Rate for Payer: First Health Commercial |
$112.50
|
| Rate for Payer: First Health Workers Compensation |
$48.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$112.50
|
| Rate for Payer: GEHA Commercial |
$100.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$112.50
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$113.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$87.50
|
| Rate for Payer: One Health Plan PPO/POS |
$112.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$118.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$116.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$50.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$34.12
|
|
|
VENLAFAXINE ER CAP 37.5 MG
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
3300937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$20.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
VENLAFAXINE ER CAP 37.5 MG
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
3300937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$23.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.40
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
VENOFER 100MG/5ML VIAL
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
3300467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$96.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$68.52
|
|
|
VENOFER 100MG/5ML VIAL
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
3300467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$96.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$0.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$65.26
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$150.60
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$125.50
|
| Rate for Payer: Zelis Worker's Compensation |
$68.52
|
|
|
VENOFER 200 MG/10 ML VIAL
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
3302909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: First Health Workers Compensation |
$145.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Worker's Compensation |
$102.65
|
|
|
VENOFER 200 MG/10 ML VIAL
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
3302909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: First Health Workers Compensation |
$145.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$0.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$102.65
|
|
|
VENOGRAM EXTRMTY BIL
|
Facility
|
IP
|
$3,240.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
2410005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cigna Commercial |
$2,754.00
|
| Rate for Payer: First Health Commercial |
$2,916.00
|
| Rate for Payer: First Health Workers Compensation |
$167.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,916.00
|
| Rate for Payer: GEHA Commercial |
$2,268.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,916.00
|
| Rate for Payer: Multiplan All |
$2,948.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,268.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,916.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,078.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,430.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,013.20
|
| Rate for Payer: Zelis Auto |
$1,296.00
|
| Rate for Payer: Zelis Worker's Compensation |
$118.29
|
|
|
VENOGRAM EXTRMTY BIL
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
2410005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,041.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,944.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,041.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$824.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cigna Commercial |
$2,754.00
|
| Rate for Payer: First Health Commercial |
$2,916.00
|
| Rate for Payer: First Health Workers Compensation |
$167.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,916.00
|
| Rate for Payer: GEHA Commercial |
$2,592.00
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,916.00
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$841.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$2,948.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,268.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,916.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$971.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$841.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,078.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,430.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Commercial |
$2,754.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$841.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,013.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$1,296.00
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$118.29
|
|
|
VENOGRAM EXTRMTY UNI
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
2410004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,041.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,592.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,041.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$824.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cigna Commercial |
$2,255.90
|
| Rate for Payer: First Health Commercial |
$2,388.60
|
| Rate for Payer: First Health Workers Compensation |
$139.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,388.60
|
| Rate for Payer: GEHA Commercial |
$2,123.20
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,388.60
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$841.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$2,415.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,857.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,388.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$971.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$841.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,521.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,990.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Commercial |
$2,255.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$841.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,468.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$1,061.60
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$98.84
|
|
|
VENOGRAM EXTRMTY UNI
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
2410004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$2,521.30 |
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cigna Commercial |
$2,255.90
|
| Rate for Payer: First Health Commercial |
$2,388.60
|
| Rate for Payer: First Health Workers Compensation |
$139.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,388.60
|
| Rate for Payer: GEHA Commercial |
$1,857.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,388.60
|
| Rate for Payer: Multiplan All |
$2,415.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,857.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,388.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,521.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,990.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,468.22
|
| Rate for Payer: Zelis Auto |
$1,061.60
|
| Rate for Payer: Zelis Worker's Compensation |
$98.84
|
|
|
VENOUS BLOOD GAS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
4047000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.86 |
| 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 |
$88.90
|
| 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 |
$62.86
|
|
|
VENOUS BLOOD GAS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
4047000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.79
|
| 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 |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$78.77
|
| 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 |
$88.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$78.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$86.65
|
| Rate for Payer: Humana Medicare Advantage |
$78.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$132.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$114.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$78.77
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.91
|
| 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 |
$132.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$114.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$78.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$157.54
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$77.19
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$78.77
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$66.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.52
|
| Rate for Payer: Zelis Worker's Compensation |
$62.86
|
|
|
VENTILATING TUBE RMVL REQUIRING GEN ANES
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
20300084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$227.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,504.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$322.15
|
| Rate for Payer: First Health Commercial |
$341.10
|
| Rate for Payer: First Health Workers Compensation |
$146.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$341.10
|
| Rate for Payer: GEHA Commercial |
$303.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$341.10
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,535.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$344.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$265.30
|
| Rate for Payer: One Health Plan PPO/POS |
$341.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,772.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,535.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$360.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$284.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,535.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$352.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$151.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$103.47
|
|
