|
CARDIO STRESS TEST (GLOBA
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 93015
|
| Hospital Charge Code |
9100008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
CARDIO STRESS TEST (GLOBA
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
9100010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Humana ChoiceCare |
$10.92
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.20
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
|
CARDIO STRESS TEST (GLOBA
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
9100010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$29.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
|
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERN
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
8192960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$540.27 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: First Health Workers Compensation |
$764.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,385.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: Zelis Auto |
$791.60
|
| Rate for Payer: Zelis Worker's Compensation |
$540.27
|
|
|
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERN
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
8192960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.92 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,187.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$621.36
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: First Health Workers Compensation |
$764.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,583.20
|
| Rate for Payer: GEHA Medicare |
$621.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Humana ChoiceCare |
$683.50
|
| Rate for Payer: Humana Medicare Advantage |
$621.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,043.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$621.36
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,056.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$621.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,242.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$621.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$621.36
|
| Rate for Payer: Zelis Auto |
$791.60
|
| Rate for Payer: Zelis Medicare |
$528.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$745.63
|
| Rate for Payer: Zelis Worker's Compensation |
$540.27
|
|
|
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERN
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4000915
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$540.27 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: First Health Workers Compensation |
$764.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,385.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: Zelis Auto |
$791.60
|
| Rate for Payer: Zelis Worker's Compensation |
$540.27
|
|
|
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERN
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4000915
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$440.92 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,187.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$621.36
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: First Health Workers Compensation |
$764.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,583.20
|
| Rate for Payer: GEHA Medicare |
$621.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Humana ChoiceCare |
$683.50
|
| Rate for Payer: Humana Medicare Advantage |
$621.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,043.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$621.36
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,056.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$621.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,242.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.93
|
| Rate for Payer: United Healthcare Commercial |
$1,682.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$621.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$621.36
|
| Rate for Payer: Zelis Auto |
$791.60
|
| Rate for Payer: Zelis Medicare |
$528.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$745.63
|
| Rate for Payer: Zelis Worker's Compensation |
$540.27
|
|
|
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERN
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
6192960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,242.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$621.36
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: GEHA Medicare |
$621.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$683.50
|
| Rate for Payer: Humana Medicare Advantage |
$621.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,043.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$621.36
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,056.31
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$621.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,242.72
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$621.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$621.36
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Medicare |
$528.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$745.63
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERN
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
6192960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
CARE MNGMNT BHVL HEALTH COND
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
9199510
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CARE MNGMNT BHVL HEALTH COND
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
9199510
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CARISOPRODOL TAB 350MG
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 69584011110
|
| Hospital Charge Code |
3300150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CARISOPRODOL TAB 350MG
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 69584011110
|
| Hospital Charge Code |
3300150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
carnitine, total and free REF706500
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
22990340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$29.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$16.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Humana ChoiceCare |
$18.56
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.87
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.68
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.74
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.87
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Medicare |
$14.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.24
|
| Rate for Payer: Zelis Worker's Compensation |
$20.92
|
|
|
carnitine, total and free REF706500
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
22990340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$29.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.92
|
|
|
carotene, beta REF001529
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
2200442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$16.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$11.45
|
|
|
carotene, beta REF001529
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
2200442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.22
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$16.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$9.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$10.14
|
| Rate for Payer: Humana Medicare Advantage |
$9.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.22
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.67
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.44
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.04
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.22
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$7.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.06
|
| Rate for Payer: Zelis Worker's Compensation |
$11.45
|
|
|
CARPAL TUNNEL/EXOLITE BRACE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8800026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
CARPAL TUNNEL/EXOLITE BRACE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8230084
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
CARPAL TUNNEL/EXOLITE BRACE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8800026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
|
|
CARPAL TUNNEL/EXOLITE BRACE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8230084
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
|
|
CARPAL TUNNEL SURGERY
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
6164721
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$605.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: Zelis Auto |
$346.00
|
| Rate for Payer: Zelis Worker's Compensation |
$236.15
|
|
|
CARPAL TUNNEL SURGERY
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
6164721
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$692.00
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$346.00
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$236.15
|
|
|
CARVEDILOL 12.5MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
3301958
|
|
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
|
|
|
CARVEDILOL 12.5MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68382009401
|
| Hospital Charge Code |
3301958
|
|
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
|
|
