|
vitamin B12 REF 001503
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
2232256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$28.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: GEHA Medicare |
$15.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$16.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.08
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.64
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.16
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$201.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.08
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Medicare |
$12.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.10
|
| Rate for Payer: Zelis Worker's Compensation |
$20.48
|
|
|
VITAMIN B12 (Vitros)
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
2232255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$28.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.48
|
|
|
VITAMIN B12 (Vitros)
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
2232255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$28.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: GEHA Medicare |
$15.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$16.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.08
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.64
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.16
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$181.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.08
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Medicare |
$12.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.10
|
| Rate for Payer: Zelis Worker's Compensation |
$20.48
|
|
|
vitamin b1 whole blood REF121186
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
2299173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$37.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$282.40
|
| Rate for Payer: GEHA Medicare |
$21.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Humana ChoiceCare |
$23.35
|
| Rate for Payer: Humana Medicare Advantage |
$21.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.23
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.09
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42.46
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$300.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.23
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Medicare |
$18.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.48
|
| Rate for Payer: Zelis Worker's Compensation |
$26.61
|
|
|
vitamin b1 whole blood REF121186
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
2299173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$37.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.61
|
|
|
vitamin b2 (riboflavin) wb REF123220
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
2299335
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.24
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$35.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$20.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$22.26
|
| Rate for Payer: Humana Medicare Advantage |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.24
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.41
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.48
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.84
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.24
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$17.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.29
|
| Rate for Payer: Zelis Worker's Compensation |
$25.10
|
|
|
vitamin b2 (riboflavin) wb REF123220
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
2299335
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$35.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.10
|
|
|
vitamin b3 REF070115
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2299855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$22.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: GEHA Medicare |
$17.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$18.77
|
| Rate for Payer: Humana Medicare Advantage |
$17.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.06
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.00
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.12
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Commercial |
$158.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.06
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Medicare |
$14.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.47
|
| Rate for Payer: Zelis Worker's Compensation |
$16.06
|
|
|
vitamin b3 REF070115
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2299855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$22.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.06
|
|
|
VITAMIN B6 PLASMA REF
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
2200204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$50.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$50.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$40.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.10
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$48.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: GEHA Medicare |
$28.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$30.91
|
| Rate for Payer: Humana Medicare Advantage |
$28.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$40.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.10
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.77
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$47.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$40.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.20
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.54
|
| Rate for Payer: United Healthcare Commercial |
$267.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.10
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Medicare |
$23.89
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.72
|
| Rate for Payer: Zelis Worker's Compensation |
$33.99
|
|
|
VITAMIN B6 PLASMA REF
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
2200204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$48.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.99
|
|
|
vitamin b6 plasma REF004655
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
2300124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$48.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.99
|
|
|
vitamin b6 plasma REF004655
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
2300124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$50.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$50.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$40.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.10
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$48.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: GEHA Medicare |
$28.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$30.91
|
| Rate for Payer: Humana Medicare Advantage |
$28.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$40.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.10
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.77
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$47.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$40.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.20
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.54
|
| Rate for Payer: United Healthcare Commercial |
$267.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.10
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Medicare |
$23.89
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.72
|
| Rate for Payer: Zelis Worker's Compensation |
$33.99
|
|
|
vitamin c plasmaREF001805
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
2200737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$18.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.98
|
|
|
vitamin c plasmaREF001805
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
2200737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.89
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$18.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$9.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$10.88
|
| Rate for Payer: Humana Medicare Advantage |
$9.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.89
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.81
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.78
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.69
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.89
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$8.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.87
|
| Rate for Payer: Zelis Worker's Compensation |
$12.98
|
|
|
vitamin D 25 hydroxy REF 081950
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2232304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$42.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: GEHA Medicare |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Humana Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$43.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.60
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.32
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$43.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59.20
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.01
|
| Rate for Payer: United Healthcare Commercial |
$282.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.60
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Medicare |
$25.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.52
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
vitamin D 25 hydroxy REF 081950
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2232304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
VITAMIN D 25-OH (Vitros)
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2232264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$42.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: GEHA Medicare |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Humana Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$43.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.60
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.32
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$43.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59.20
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.01
|
| Rate for Payer: United Healthcare Commercial |
$282.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.60
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Medicare |
$25.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.52
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
VITAMIN D 25-OH (Vitros)
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2232264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
VITAMIN D3 1000 UNITS TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 79854005024
|
| Hospital Charge Code |
3301369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
VITAMIN D3 1000 UNITS TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 79854005024
|
| Hospital Charge Code |
3301369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
VITAMIN D3 5000 UNITS TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 07610017840
|
| Hospital Charge Code |
3302969
|
|
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
|
|
|
VITAMIN D3 5000 UNITS TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 07610017840
|
| Hospital Charge Code |
3302969
|
|
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
|
|
|
VITAMIN E 400 UNIT CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 54629040001
|
| Hospital Charge Code |
3300942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
VITAMIN E 400 UNIT CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 54629040001
|
| Hospital Charge Code |
3300942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
