|
CLINDAMYCIN IVPB 600MG/50ML - Premix
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
NDC 00338954950
|
| Hospital Charge Code |
3300189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
CLINDAMYCIN IVPB 900MG/100ML - Premix
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3302907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$38.40
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
CLINDAMYCIN IVPB 900MG/100ML - Premix
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3302907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
CLINDAMYCIN IVPB 900 MG/50 ML - Premix
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
NDC 00338955324
|
| Hospital Charge Code |
3302967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
CLINDAMYCIN IVPB 900 MG/50 ML - Premix
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
NDC 00338955324
|
| Hospital Charge Code |
3302967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$31.46
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.60
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$106.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.50
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
CLINDAMYCIN/NS 600MG/50ML
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
NDC 00338954924
|
| Hospital Charge Code |
3302299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$91.80
|
| Rate for Payer: First Health Commercial |
$97.20
|
| Rate for Payer: First Health Workers Compensation |
$41.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.20
|
| Rate for Payer: GEHA Commercial |
$75.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.20
|
| Rate for Payer: Multiplan All |
$98.28
|
| Rate for Payer: OMNI Networks Commercial |
$75.60
|
| Rate for Payer: One Health Plan PPO/POS |
$97.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$102.60
|
| Rate for Payer: Three Rivers Provider Network All |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$100.44
|
| Rate for Payer: Zelis Auto |
$43.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.48
|
|
|
CLINDAMYCIN/NS 600MG/50ML
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
NDC 00338954924
|
| Hospital Charge Code |
3302299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$91.80
|
| Rate for Payer: First Health Commercial |
$97.20
|
| Rate for Payer: First Health Workers Compensation |
$41.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.20
|
| Rate for Payer: GEHA Commercial |
$86.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.20
|
| Rate for Payer: Humana ChoiceCare |
$28.08
|
| Rate for Payer: Multiplan All |
$98.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.80
|
| Rate for Payer: OMNI Networks Commercial |
$75.60
|
| Rate for Payer: One Health Plan PPO/POS |
$97.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$102.60
|
| Rate for Payer: Three Rivers Provider Network All |
$81.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$95.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$100.44
|
| Rate for Payer: Zelis Auto |
$43.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.00
|
| Rate for Payer: Zelis Worker's Compensation |
$29.48
|
|
|
CL- INFLIXIMAB 10 MG
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
3350354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$186.15
|
| Rate for Payer: First Health Commercial |
$197.10
|
| Rate for Payer: First Health Workers Compensation |
$84.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$197.10
|
| Rate for Payer: GEHA Commercial |
$153.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$197.10
|
| Rate for Payer: Multiplan All |
$199.29
|
| Rate for Payer: OMNI Networks Commercial |
$153.30
|
| Rate for Payer: One Health Plan PPO/POS |
$197.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$208.05
|
| Rate for Payer: Three Rivers Provider Network All |
$164.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$203.67
|
| Rate for Payer: Zelis Auto |
$87.60
|
| Rate for Payer: Zelis Worker's Compensation |
$59.79
|
|
|
CL- INFLIXIMAB 10 MG
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
3350354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$114.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$131.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$114.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$90.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$186.15
|
| Rate for Payer: First Health Commercial |
$197.10
|
| Rate for Payer: First Health Workers Compensation |
$84.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$197.10
|
| Rate for Payer: GEHA Commercial |
$34.20
|
| Rate for Payer: GEHA Medicare |
$31.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$197.10
|
| Rate for Payer: Humana ChoiceCare |
$34.20
|
| Rate for Payer: Humana Medicare Advantage |
$31.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$52.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$92.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$31.09
|
| Rate for Payer: Multiplan All |
$199.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.85
|
| Rate for Payer: OMNI Networks Commercial |
$153.30
|
| Rate for Payer: One Health Plan PPO/POS |
$197.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$107.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$92.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$31.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$208.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$62.18
|
| Rate for Payer: Three Rivers Provider Network All |
$164.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.47
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$203.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$31.09
|
| Rate for Payer: Zelis Auto |
$87.60
|
| Rate for Payer: Zelis Medicare |
$26.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$37.31
|
| Rate for Payer: Zelis Worker's Compensation |
$59.79
|
|
|
CLINIC COVID19 AND INFLU A&B ANTIGEN
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 87428
|
| Hospital Charge Code |
7300027
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
CLINIC COVID19 AND INFLU A&B ANTIGEN
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 87428
|
| Hospital Charge Code |
7300027
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$83.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$70.29
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: GEHA Medicare |
$70.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Humana ChoiceCare |
$77.32
|
| Rate for Payer: Humana Medicare Advantage |
$70.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$118.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$70.29
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.49
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$98.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$85.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$70.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$140.58
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$68.88
|
| Rate for Payer: United Healthcare Commercial |
$279.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$70.29
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Medicare |
$59.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.35
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
CLINIC COVID19 STAT 15 MIN CARLSBAD
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
7300024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
CLINIC COVID19 STAT 15 MIN CARLSBAD
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
7300024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$60.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$51.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$56.44
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$86.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$51.31
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.23
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$51.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$102.62
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.28
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$51.31
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$43.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.57
|
| Rate for Payer: Zelis Worker's Compensation |
$42.71
|
|
|
CLINIC GLUCOSE POCT
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
7300015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$32.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
CLINIC GLUCOSE POCT
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
7300015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$37.60
|
| Rate for Payer: GEHA Medicare |
$5.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.04
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.57
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.08
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.94
|
| Rate for Payer: United Healthcare Commercial |
$39.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.04
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Medicare |
$4.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.05
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
CLINIC INFLUENZA A
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
7300003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$62.40
|
| Rate for Payer: GEHA Medicare |
$16.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.55
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.14
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$66.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.55
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Medicare |
$14.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.86
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
CLINIC INFLUENZA A
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
7300003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$54.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
CLINIC INFLUENZA B
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
7300004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$54.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
CLINIC INFLUENZA B
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
7300004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$62.40
|
| Rate for Payer: GEHA Medicare |
$16.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.55
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.14
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$66.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.55
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Medicare |
$14.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.86
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
CLINIC PT & INR
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
7300026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
CLINIC PT & INR
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
7300026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.81
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$16.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$18.49
|
| Rate for Payer: Humana Medicare Advantage |
$16.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.81
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.58
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.62
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.81
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$14.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.17
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
CLINIC RAPID STR A
|
Facility
|
OP
|
$169.24
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
7286403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$101.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cigna Commercial |
$143.85
|
| Rate for Payer: First Health Commercial |
$152.32
|
| Rate for Payer: First Health Workers Compensation |
$18.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$152.32
|
| Rate for Payer: GEHA Commercial |
$135.39
|
| Rate for Payer: GEHA Medicare |
$11.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$152.32
|
| Rate for Payer: Humana ChoiceCare |
$12.69
|
| Rate for Payer: Humana Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.54
|
| Rate for Payer: Multiplan All |
$154.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.62
|
| Rate for Payer: OMNI Networks Commercial |
$118.47
|
| Rate for Payer: One Health Plan PPO/POS |
$152.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$160.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.08
|
| Rate for Payer: Three Rivers Provider Network All |
$126.93
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.31
|
| Rate for Payer: United Healthcare Commercial |
$143.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$157.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.54
|
| Rate for Payer: Zelis Auto |
$67.70
|
| Rate for Payer: Zelis Medicare |
$9.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.85
|
| Rate for Payer: Zelis Worker's Compensation |
$13.12
|
|
|
CLINIC RAPID STR A
|
Facility
|
IP
|
$169.24
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
7286403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cigna Commercial |
$143.85
|
| Rate for Payer: First Health Commercial |
$152.32
|
| Rate for Payer: First Health Workers Compensation |
$18.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$152.32
|
| Rate for Payer: GEHA Commercial |
$118.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$152.32
|
| Rate for Payer: Multiplan All |
$154.01
|
| Rate for Payer: OMNI Networks Commercial |
$118.47
|
| Rate for Payer: One Health Plan PPO/POS |
$152.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$160.78
|
| Rate for Payer: Three Rivers Provider Network All |
$126.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$157.39
|
| Rate for Payer: Zelis Auto |
$67.70
|
| Rate for Payer: Zelis Worker's Compensation |
$13.12
|
|
|
CLINIC RAPID STR A
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
8586403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$18.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.12
|
|
|
CLINIC RAPID STR A
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
8586403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.54
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$18.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: GEHA Medicare |
$11.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$12.69
|
| Rate for Payer: Humana Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.54
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.62
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.08
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.31
|
| Rate for Payer: United Healthcare Commercial |
$43.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.54
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Medicare |
$9.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.85
|
| Rate for Payer: Zelis Worker's Compensation |
$13.12
|
|
