|
CL- RISPERDAL CONSTA 37.5 MG INJ-PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J2794
|
| Hospital Charge Code |
3302598
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$21.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$12.08
|
| Rate for Payer: GEHA Medicare |
$10.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$12.08
|
| Rate for Payer: Humana Medicare Advantage |
$10.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.98
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.67
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.96
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.98
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$9.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.18
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERDAL CONSTA 37.5 MG INJ-PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J2794
|
| Hospital Charge Code |
3302598
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERIDONE SY100MG/0.28ML PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J2799
|
| Hospital Charge Code |
3350547
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERIDONE SY100MG/0.28ML PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J2799
|
| Hospital Charge Code |
3350547
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$50.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.04
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$27.54
|
| Rate for Payer: GEHA Medicare |
$25.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$27.54
|
| Rate for Payer: Humana Medicare Advantage |
$25.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.04
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.57
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.08
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.04
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$21.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.05
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERIDONE SY50MG/0.14ML ER PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J2799
|
| Hospital Charge Code |
3350548
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$50.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.04
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$27.54
|
| Rate for Payer: GEHA Medicare |
$25.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$27.54
|
| Rate for Payer: Humana Medicare Advantage |
$25.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.04
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.57
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.08
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.04
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$21.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.05
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERIDONE SY50MG/0.14ML ER PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J2799
|
| Hospital Charge Code |
3350548
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERRIDONE SY75MG/0.21ML ER PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J2799
|
| Hospital Charge Code |
3350546
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RISPERRIDONE SY75MG/0.21ML ER PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J2799
|
| Hospital Charge Code |
3350546
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$50.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.04
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$27.54
|
| Rate for Payer: GEHA Medicare |
$25.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$27.54
|
| Rate for Payer: Humana Medicare Advantage |
$25.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.04
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.57
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.08
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.04
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$21.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.05
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- RITUXIMAB 10 MG
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
3350355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: First Health Commercial |
$261.00
|
| Rate for Payer: First Health Workers Compensation |
$111.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.00
|
| Rate for Payer: GEHA Commercial |
$82.74
|
| Rate for Payer: GEHA Medicare |
$75.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.00
|
| Rate for Payer: Humana ChoiceCare |
$82.74
|
| Rate for Payer: Humana Medicare Advantage |
$75.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$126.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$144.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$75.22
|
| Rate for Payer: Multiplan All |
$263.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.87
|
| Rate for Payer: OMNI Networks Commercial |
$203.00
|
| Rate for Payer: One Health Plan PPO/POS |
$261.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$144.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$75.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$275.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$150.44
|
| Rate for Payer: Three Rivers Provider Network All |
$217.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$269.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$75.22
|
| Rate for Payer: Zelis Auto |
$116.00
|
| Rate for Payer: Zelis Medicare |
$63.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.26
|
| Rate for Payer: Zelis Worker's Compensation |
$79.17
|
|
|
CL- RITUXIMAB 10 MG
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT J9312
|
| Hospital Charge Code |
3350355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.17 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: First Health Commercial |
$261.00
|
| Rate for Payer: First Health Workers Compensation |
$111.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.00
|
| Rate for Payer: GEHA Commercial |
$203.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.00
|
| Rate for Payer: Multiplan All |
$263.90
|
| Rate for Payer: OMNI Networks Commercial |
$203.00
|
| Rate for Payer: One Health Plan PPO/POS |
$261.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$275.50
|
| Rate for Payer: Three Rivers Provider Network All |
$217.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$269.70
|
| Rate for Payer: Zelis Auto |
$116.00
|
| Rate for Payer: Zelis Worker's Compensation |
$79.17
|
|
|
CL- RITUXIMAB-ABBS 10 MG/ML
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT Q5115
|
| Hospital Charge Code |
3350443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.83 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$276.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
|
CL- RITUXIMAB-ABBS 10 MG/ML
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT Q5115
|
| Hospital Charge Code |
3350443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$32.32
|
| Rate for Payer: GEHA Medicare |
$29.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Humana ChoiceCare |
$32.32
|
| Rate for Payer: Humana Medicare Advantage |
$29.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.38
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.95
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$58.76
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.38
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Medicare |
$24.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.26
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
|
CL- RITUXIMAB/HYALURONIDASE 10 MG
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
3350357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
CL- RITUXIMAB/HYALURONIDASE 10 MG
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT J9311
|
| Hospital Charge Code |
3350357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.19 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.69
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$40.36
|
| Rate for Payer: GEHA Medicare |
$36.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$40.36
|
| Rate for Payer: Humana Medicare Advantage |
$36.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$61.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.69
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$62.37
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$73.38
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.69
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$31.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.03
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
CL- RIVAROXABAN TAB 15 MG
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
3350079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$74.10 |
| 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 |
$30.12
|
| 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 |
$21.29
|
|
|
CL- RIVAROXABAN TAB 15 MG
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
3350079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$30.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$62.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$20.28
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$68.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.29
|
|
|
CL- ROMIPLOSTIM 10 MCG VIAL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT J2796
|
| Hospital Charge Code |
3350334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
CL- ROMIPLOSTIM 10 MCG VIAL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT J2796
|
| Hospital Charge Code |
3350334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.68 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$82.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$82.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$65.68
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$56.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.01
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.80
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$77.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$191.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.00
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
CL- ROMOSOZUMAB 105 MG/1.17 ML
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
33505451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$982.80 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cigna Commercial |
$3,060.00
|
| Rate for Payer: First Health Commercial |
$3,240.00
|
| Rate for Payer: First Health Workers Compensation |
$1,389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,240.00
|
| Rate for Payer: GEHA Commercial |
$2,520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,240.00
|
| Rate for Payer: Multiplan All |
$3,276.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,520.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,240.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,420.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,700.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,348.00
|
| Rate for Payer: Zelis Auto |
$1,440.00
|
| Rate for Payer: Zelis Worker's Compensation |
$982.80
|
|
|
CL- ROMOSOZUMAB 105 MG/1.17 ML
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
33505451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cigna Commercial |
$3,060.00
|
| Rate for Payer: First Health Commercial |
$3,240.00
|
| Rate for Payer: First Health Workers Compensation |
$1,389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,240.00
|
| Rate for Payer: GEHA Commercial |
$13.28
|
| Rate for Payer: GEHA Medicare |
$12.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,240.00
|
| Rate for Payer: Humana ChoiceCare |
$13.28
|
| Rate for Payer: Humana Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.07
|
| Rate for Payer: Multiplan All |
$3,276.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.52
|
| Rate for Payer: OMNI Networks Commercial |
$2,520.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,240.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,420.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.14
|
| Rate for Payer: Three Rivers Provider Network All |
$2,700.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,348.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.07
|
| Rate for Payer: Zelis Auto |
$1,440.00
|
| Rate for Payer: Zelis Medicare |
$10.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.48
|
| Rate for Payer: Zelis Worker's Compensation |
$982.80
|
|
|
CL- ROMOSOZUMAB 210MG/2.34ML
|
Facility
|
OP
|
$7,200.00
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
3350531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$6,840.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$6,120.00
|
| Rate for Payer: First Health Commercial |
$6,480.00
|
| Rate for Payer: First Health Workers Compensation |
$2,779.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,480.00
|
| Rate for Payer: GEHA Commercial |
$13.28
|
| Rate for Payer: GEHA Medicare |
$12.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,480.00
|
| Rate for Payer: Humana ChoiceCare |
$13.28
|
| Rate for Payer: Humana Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.07
|
| Rate for Payer: Multiplan All |
$6,552.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.52
|
| Rate for Payer: OMNI Networks Commercial |
$5,040.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,480.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,840.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.14
|
| Rate for Payer: Three Rivers Provider Network All |
$5,400.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,696.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.07
|
| Rate for Payer: Zelis Auto |
$2,880.00
|
| Rate for Payer: Zelis Medicare |
$10.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.48
|
| Rate for Payer: Zelis Worker's Compensation |
$1,965.60
|
|
|
CL- ROMOSOZUMAB 210MG/2.34ML
|
Facility
|
IP
|
$7,200.00
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
3350531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,965.60 |
| Max. Negotiated Rate |
$6,840.00 |
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$6,120.00
|
| Rate for Payer: First Health Commercial |
$6,480.00
|
| Rate for Payer: First Health Workers Compensation |
$2,779.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,480.00
|
| Rate for Payer: GEHA Commercial |
$5,040.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,480.00
|
| Rate for Payer: Multiplan All |
$6,552.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,040.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,480.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,840.00
|
| Rate for Payer: Three Rivers Provider Network All |
$5,400.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,696.00
|
| Rate for Payer: Zelis Auto |
$2,880.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,965.60
|
|
|
CL- ROMOSOZUMAB 210 MG/ 2.34 ML PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
3350521
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$13.28
|
| Rate for Payer: GEHA Medicare |
$12.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$13.28
|
| Rate for Payer: Humana Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.07
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.52
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.14
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.07
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$10.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.48
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- ROMOSOZUMAB 210 MG/ 2.34 ML PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
3350521
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- ROPIVACAINE INJ 1 MG
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3350416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
