|
VORICONAZOLE 200 MG IV VIAL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT J3465
|
| Hospital Charge Code |
3303111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.41
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$170.00
|
| Rate for Payer: First Health Commercial |
$180.00
|
| Rate for Payer: First Health Workers Compensation |
$77.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.00
|
| Rate for Payer: GEHA Commercial |
$0.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.00
|
| Rate for Payer: Humana ChoiceCare |
$52.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4.50
|
| Rate for Payer: Multiplan All |
$182.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$120.00
|
| Rate for Payer: OMNI Networks Commercial |
$140.00
|
| Rate for Payer: One Health Plan PPO/POS |
$180.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.00
|
| Rate for Payer: Three Rivers Provider Network All |
$150.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$176.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.00
|
| Rate for Payer: Zelis Auto |
$80.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.00
|
| Rate for Payer: Zelis Worker's Compensation |
$54.60
|
|
|
voriconazole, level
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
2200007
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27.11
|
| 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 |
$31.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$27.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$29.82
|
| Rate for Payer: Humana Medicare Advantage |
$27.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27.11
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.09
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$54.22
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.57
|
| Rate for Payer: United Healthcare Commercial |
$213.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$27.11
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$23.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.53
|
| Rate for Payer: Zelis Worker's Compensation |
$21.96
|
|
|
voriconazole, level
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
2200007
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$238.45 |
| 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 |
$31.06
|
| 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 |
$21.96
|
|
|
VP IMADM ANY ROUTE 1ST VAC/T
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
8599448
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
VP IMADM ANY ROUTE 1ST VAC/T
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
8599448
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
VP IMMUNIZATION ADMIN
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8599450
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$14.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
VP IMMUNIZATION ADMIN
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8599450
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$16.64
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
VP IMMUNIZATION ADMIN, EACH
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8599451
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$16.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Humana ChoiceCare |
$5.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.48
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
VP IMMUNIZATION ADMIN, EACH
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8599451
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: First Health Commercial |
$18.72
|
| Rate for Payer: First Health Workers Compensation |
$8.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.72
|
| Rate for Payer: GEHA Commercial |
$14.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.72
|
| Rate for Payer: Multiplan All |
$18.93
|
| Rate for Payer: OMNI Networks Commercial |
$14.56
|
| Rate for Payer: One Health Plan PPO/POS |
$18.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.76
|
| Rate for Payer: Three Rivers Provider Network All |
$15.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.34
|
| Rate for Payer: Zelis Auto |
$8.32
|
| Rate for Payer: Zelis Worker's Compensation |
$5.68
|
|
|
VP INADM ANY ROUTE ADDL VAC/
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
8599449
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
VP INADM ANY ROUTE ADDL VAC/
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
8599449
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$6,038.18
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,605.60 |
| 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 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: First Health Workers Compensation |
$3,885.57
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| 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: New Mexico Health Connections Medicare |
$5,132.45
|
| 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 Worker's Compensation |
$6,038.18
|
| 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: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| 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 |
$2,747.37
|
|
|
VW MULTIMERIC ANALYSIS
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2299409
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$40.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: GEHA Medicare |
$22.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| Rate for Payer: Humana ChoiceCare |
$25.23
|
| Rate for Payer: Humana Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$38.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$33.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$22.94
|
| Rate for Payer: Multiplan All |
$293.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.00
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$33.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$22.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$305.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$45.88
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.48
|
| Rate for Payer: United Healthcare Commercial |
$273.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$299.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$22.94
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Medicare |
$19.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.53
|
| Rate for Payer: Zelis Worker's Compensation |
$28.64
|
|
|
VW MULTIMERIC ANALYSIS
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2299409
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$40.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$225.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| Rate for Payer: Multiplan All |
$293.02
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$305.90
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$299.46
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Worker's Compensation |
$28.64
|
|
|
WALK BOOT PNEUMATC PREFAB W/FIT&ADJ
|
Facility
|
IP
|
$727.10
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
854360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.84 |
| Max. Negotiated Rate |
$690.75 |
| Rate for Payer: Cash Price |
$436.26
|
| Rate for Payer: Cash Price |
$436.26
|
| Rate for Payer: Cigna Commercial |
$618.03
|
| Rate for Payer: First Health Commercial |
$654.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.39
|
| Rate for Payer: GEHA Commercial |
$508.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.39
|
| Rate for Payer: Multiplan All |
$661.66
|
| Rate for Payer: OMNI Networks Commercial |
$508.97
|
| Rate for Payer: One Health Plan PPO/POS |
$654.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.75
|
| Rate for Payer: Three Rivers Provider Network All |
$545.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.20
|
| Rate for Payer: Zelis Auto |
$290.84
|
|
|
WALK BOOT PNEUMATC PREFAB W/FIT&ADJ
|
Facility
|
OP
|
$727.10
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
854360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.05 |
| Max. Negotiated Rate |
$690.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$467.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$436.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$467.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$370.68
|
| Rate for Payer: Cash Price |
$436.26
|
| Rate for Payer: Cash Price |
$436.26
|
| Rate for Payer: Cash Price |
$436.26
|
| Rate for Payer: Cigna Commercial |
$618.03
|
| Rate for Payer: First Health Commercial |
$654.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.39
|
| Rate for Payer: GEHA Commercial |
$581.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.39
|
| Rate for Payer: Humana ChoiceCare |
$189.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$378.23
|
| Rate for Payer: Multiplan All |
$661.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$436.26
|
| Rate for Payer: OMNI Networks Commercial |
$508.97
|
| Rate for Payer: One Health Plan PPO/POS |
$654.39
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$436.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$378.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.75
|
| Rate for Payer: Three Rivers Provider Network All |
$545.33
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$639.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$378.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.20
|
| Rate for Payer: Zelis Auto |
$290.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$363.55
|
|
|
WALK BOOT PNEUMATC PREFAB W/FIT&ADJ
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
8230056
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
|
|
WALK BOOT PNEUMATC PREFAB W/FIT&ADJ
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
8230056
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$467.91 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$467.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$467.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$370.68
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$57.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$378.23
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$132.60
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$436.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$378.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$194.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$378.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$110.50
|
|
|
walnut IgE REF602530
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
walnut IgE REF602530
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
WARFARIN SODIUM 1MG TAB
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 00093171201
|
| Hospital Charge Code |
3300944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
WARFARIN SODIUM 1MG TAB
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 00093171201
|
| Hospital Charge Code |
3300944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
WARFARIN SODIUM 2.5MG TAB
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 68084002701
|
| Hospital Charge Code |
3300945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
WARFARIN SODIUM 2.5MG TAB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 68084002701
|
| Hospital Charge Code |
3300945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
WARFARIN SODIUM 2MG TAB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 62584098401
|
| Hospital Charge Code |
3300946
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
