|
CL- METHOCARBAMOL 1000MG/10 ML INJECTION
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT J2800
|
| Hospital Charge Code |
3350405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$99.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$179.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.16
|
|
|
CL- METHOCARBAMOL 1000MG/10 ML INJECTION
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT J2800
|
| Hospital Charge Code |
3350405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.63
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$99.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$5.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| Rate for Payer: Humana ChoiceCare |
$66.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.82
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$154.20
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$128.50
|
| Rate for Payer: Zelis Worker's Compensation |
$70.16
|
|
|
CL- METHOCARBAMOL 500 MG TAB
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 70010075401
|
| Hospital Charge Code |
3350406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CL- METHOCARBAMOL 500 MG TAB
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 70010075401
|
| Hospital Charge Code |
3350406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CL- METHOTREXATE 50 MG/ 2 ML INJ
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT J9260
|
| Hospital Charge Code |
3350271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$3.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.00
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
CL- METHOTREXATE 50 MG/ 2 ML INJ
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT J9260
|
| Hospital Charge Code |
3350271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
CL- METHYLPREDNISOLONE ACE 40MG/ML; DEPO
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT J1010
|
| Hospital Charge Code |
3350060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$27.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
CL- METHYLPREDNISOLONE ACE 40MG/ML; DEPO
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT J1010
|
| Hospital Charge Code |
3350060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$0.13
|
| Rate for Payer: GEHA Medicare |
$0.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$0.13
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$0.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$0.12
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.20
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$0.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$0.24
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$0.12
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Medicare |
$0.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.14
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
CL- METHYLPREDNISOLONE ACE 80 MG/ML IM
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT J1010
|
| Hospital Charge Code |
3350061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
CL- METHYLPREDNISOLONE ACE 80 MG/ML IM
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT J1010
|
| Hospital Charge Code |
3350061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$0.13
|
| Rate for Payer: GEHA Medicare |
$0.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$0.13
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$0.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$0.12
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.20
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$0.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$0.24
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$0.12
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Medicare |
$0.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.14
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
CL- METHYLPREDNISOLONE INJ 125MG
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT J2919
|
| Hospital Charge Code |
3350062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
CL- METHYLPREDNISOLONE INJ 125MG
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT J2919
|
| Hospital Charge Code |
3350062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$0.23
|
| Rate for Payer: GEHA Medicare |
$0.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Humana ChoiceCare |
$0.23
|
| Rate for Payer: Humana Medicare Advantage |
$0.21
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$0.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$0.21
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.36
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$0.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$0.42
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$0.21
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Medicare |
$0.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.25
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
CL- METOCLOPRAMIDE HCL 10 MG /2 ML INJ
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J2765
|
| Hospital Charge Code |
3350413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$1.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CL- METOCLOPRAMIDE HCL 10 MG /2 ML INJ
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J2765
|
| Hospital Charge Code |
3350413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CL- METOPROLOL TARTRATE TAB 50 MG
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 51079080120
|
| Hospital Charge Code |
3350063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
CL- METOPROLOL TARTRATE TAB 50 MG
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 51079080120
|
| Hospital Charge Code |
3350063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
CL- Milk of Magnesia - 30 ML UD
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 66689005301
|
| Hospital Charge Code |
3350395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CL- Milk of Magnesia - 30 ML UD
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 66689005301
|
| Hospital Charge Code |
3350395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CL- MITOMYCIN 40 MG INJ
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3350497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$863.60
|
| Rate for Payer: First Health Commercial |
$914.40
|
| Rate for Payer: First Health Workers Compensation |
$392.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$914.40
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$914.40
|
| Rate for Payer: Multiplan All |
$924.56
|
| Rate for Payer: OMNI Networks Commercial |
$711.20
|
| Rate for Payer: One Health Plan PPO/POS |
$914.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$965.20
|
| Rate for Payer: Three Rivers Provider Network All |
$762.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$944.88
|
| Rate for Payer: Zelis Auto |
$406.40
|
| Rate for Payer: Zelis Worker's Compensation |
$277.37
|
|
|
CL- MITOMYCIN 40 MG INJ
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3350497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$609.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$863.60
|
| Rate for Payer: First Health Commercial |
$914.40
|
| Rate for Payer: First Health Workers Compensation |
$392.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$914.40
|
| Rate for Payer: GEHA Commercial |
$22.39
|
| Rate for Payer: GEHA Medicare |
$20.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$914.40
|
| Rate for Payer: Humana ChoiceCare |
$22.39
|
| Rate for Payer: Humana Medicare Advantage |
$20.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$79.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.35
|
| Rate for Payer: Multiplan All |
$924.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.59
|
| Rate for Payer: OMNI Networks Commercial |
$711.20
|
| Rate for Payer: One Health Plan PPO/POS |
$914.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$79.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$965.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.70
|
| Rate for Payer: Three Rivers Provider Network All |
$762.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$944.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.35
|
| Rate for Payer: Zelis Auto |
$406.40
|
| Rate for Payer: Zelis Medicare |
$17.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.42
|
| Rate for Payer: Zelis Worker's Compensation |
$277.37
|
|
|
CL- MITOMYCIN 40MG VIAL
|
Facility
|
OP
|
$2,792.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3350145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$2,652.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,675.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cigna Commercial |
$2,373.20
|
| Rate for Payer: First Health Commercial |
$2,512.80
|
| Rate for Payer: First Health Workers Compensation |
$1,077.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,512.80
|
| Rate for Payer: GEHA Commercial |
$22.39
|
| Rate for Payer: GEHA Medicare |
$20.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,512.80
|
| Rate for Payer: Humana ChoiceCare |
$22.39
|
| Rate for Payer: Humana Medicare Advantage |
$20.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$79.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.35
|
| Rate for Payer: Multiplan All |
$2,540.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,954.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,512.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$79.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,652.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,094.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,596.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.35
|
| Rate for Payer: Zelis Auto |
$1,116.80
|
| Rate for Payer: Zelis Medicare |
$17.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.42
|
| Rate for Payer: Zelis Worker's Compensation |
$762.22
|
|
|
CL- MITOMYCIN 40MG VIAL
|
Facility
|
IP
|
$2,792.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3350145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$762.22 |
| Max. Negotiated Rate |
$2,652.40 |
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cigna Commercial |
$2,373.20
|
| Rate for Payer: First Health Commercial |
$2,512.80
|
| Rate for Payer: First Health Workers Compensation |
$1,077.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,512.80
|
| Rate for Payer: GEHA Commercial |
$1,954.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,512.80
|
| Rate for Payer: Multiplan All |
$2,540.72
|
| Rate for Payer: OMNI Networks Commercial |
$1,954.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,512.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,652.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,094.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,596.56
|
| Rate for Payer: Zelis Auto |
$1,116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$762.22
|
|
|
CL- MITOMYCIN 5 MG
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3350331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.37 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$136.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Worker's Compensation |
$96.37
|
|
|
CL- MITOMYCIN 5 MG
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3350331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$136.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$22.39
|
| Rate for Payer: GEHA Medicare |
$20.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Humana ChoiceCare |
$22.39
|
| Rate for Payer: Humana Medicare Advantage |
$20.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$79.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.35
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.59
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$79.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.70
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.35
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Medicare |
$17.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.42
|
| Rate for Payer: Zelis Worker's Compensation |
$96.37
|
|
|
CL- MONOVISC 88 MG/4 ML
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT J7327
|
| Hospital Charge Code |
3350241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$541.10 |
| Max. Negotiated Rate |
$4,640.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,468.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,931.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,468.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,163.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$636.59
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,152.25
|
| Rate for Payer: First Health Commercial |
$4,396.50
|
| Rate for Payer: First Health Workers Compensation |
$1,886.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,396.50
|
| Rate for Payer: GEHA Commercial |
$700.25
|
| Rate for Payer: GEHA Medicare |
$636.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,396.50
|
| Rate for Payer: Humana ChoiceCare |
$700.25
|
| Rate for Payer: Humana Medicare Advantage |
$636.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,069.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,187.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$636.59
|
| Rate for Payer: Multiplan All |
$4,445.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,082.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,419.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,396.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,370.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,187.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$636.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,640.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,273.18
|
| Rate for Payer: Three Rivers Provider Network All |
$3,663.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$623.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,187.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$636.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,543.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$636.59
|
| Rate for Payer: Zelis Auto |
$1,954.00
|
| Rate for Payer: Zelis Medicare |
$541.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$763.91
|
| Rate for Payer: Zelis Worker's Compensation |
$1,333.61
|
|
