|
CHEMODENERV TRUNK MUSC 6/>
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
6164647
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna Commercial |
$363.80
|
| Rate for Payer: First Health Commercial |
$385.20
|
| Rate for Payer: First Health Workers Compensation |
$165.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$385.20
|
| Rate for Payer: GEHA Commercial |
$342.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$385.20
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$389.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$299.60
|
| Rate for Payer: One Health Plan PPO/POS |
$385.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$406.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$321.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$171.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$116.84
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
21600320
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
21600320
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$205.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$209.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$209.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
9464615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$205.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$209.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$209.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
6164615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
9464615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
8564615
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$205.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$209.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$209.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
6164615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$205.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$209.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$209.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIG
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
8564615
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$179.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$126.67
|
|
|
CHEMO HORMON ANTINEOPL SQ
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
8900025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$74.80
|
| Rate for Payer: First Health Commercial |
$79.20
|
| Rate for Payer: First Health Workers Compensation |
$33.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.20
|
| Rate for Payer: GEHA Commercial |
$70.40
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.20
|
| 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 |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$80.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$61.60
|
| Rate for Payer: One Health Plan PPO/POS |
$79.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$83.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$66.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$81.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$35.20
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.02
|
|
|
CHEMO HORMON ANTINEOPL SQ
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
8900025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$74.80
|
| Rate for Payer: First Health Commercial |
$79.20
|
| Rate for Payer: First Health Workers Compensation |
$33.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.20
|
| Rate for Payer: GEHA Commercial |
$61.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.20
|
| Rate for Payer: Multiplan All |
$80.08
|
| Rate for Payer: OMNI Networks Commercial |
$61.60
|
| Rate for Payer: One Health Plan PPO/POS |
$79.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$83.60
|
| Rate for Payer: Three Rivers Provider Network All |
$66.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$81.84
|
| Rate for Payer: Zelis Auto |
$35.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.02
|
|
|
CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
24700008
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| 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 |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$75.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
24700008
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
24700009
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$157.60
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| 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 |
$91.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$167.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
24500009
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$157.60
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| 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 |
$91.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$167.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
24500009
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$137.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
24700009
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$137.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBS
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
24700007
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$266.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$266.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Commercial |
$345.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBS
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
24500008
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| 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 |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$75.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBS
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
24700007
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBS
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
24500007
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBS
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
24500007
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$329.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$266.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$266.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Commercial |
$345.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBS
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
24500008
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
24500013
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
24700013
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
