|
DM SLF-MGMT TRN SRVC GRP-30 MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
21900109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.58
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.91
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
DNA DIAGNOSTICS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
2200207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
DNA DIAGNOSTICS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
2200207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.00
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$48.40
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
DNU IMPLT CLIP,EASY EZ15-15-15
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90006611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.60 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,023.20
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$3,520.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
|
|
DNU IMPLT CLIP,EASY EZ15-15-15
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90006611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.25 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$4,023.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Humana ChoiceCare |
$1,307.54
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,017.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,425.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,514.50
|
|
|
DOA DRUG SCRN IN-HOUSE UA
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
2232662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$19.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$277.60
|
| Rate for Payer: GEHA Medicare |
$17.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Humana ChoiceCare |
$18.85
|
| Rate for Payer: Humana Medicare Advantage |
$17.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.14
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.14
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.28
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$294.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.14
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Medicare |
$14.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.57
|
| Rate for Payer: Zelis Worker's Compensation |
$14.00
|
|
|
DOA DRUG SCRN IN-HOUSE UA
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
2232662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$19.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$242.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.00
|
|
|
DOA For Client REF
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
22990401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$19.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$242.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.00
|
|
|
DOA For Client REF
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
22990401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$19.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$277.60
|
| Rate for Payer: GEHA Medicare |
$17.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Humana ChoiceCare |
$18.85
|
| Rate for Payer: Humana Medicare Advantage |
$17.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.14
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.14
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.28
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$294.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.14
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Medicare |
$14.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.57
|
| Rate for Payer: Zelis Worker's Compensation |
$14.00
|
|
|
doa saliva non coc ref
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
2299259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$19.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$242.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.00
|
|
|
doa saliva non coc ref
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
2299259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$19.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$277.60
|
| Rate for Payer: GEHA Medicare |
$17.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Humana ChoiceCare |
$18.85
|
| Rate for Payer: Humana Medicare Advantage |
$17.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.14
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.14
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.28
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$294.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.14
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Medicare |
$14.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.57
|
| Rate for Payer: Zelis Worker's Compensation |
$14.00
|
|
|
doa screen 10w/ rflx wholebloodREF700886
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
doa screen 10w/ rflx wholebloodREF700886
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
doa screen 12w/ rflx wholebloodREF700896
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
22003425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
doa screen 12w/ rflx wholebloodREF700896
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
22003425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
DOBUTamine 500MG/250ML PREMIX
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
3300269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
DOBUTamine 500MG/250ML PREMIX
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
3300269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$7.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$13.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.00
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
DOCUSATE SODIUM 100MG/10ML LIQUID
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300272
|
|
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
|
|
|
DOCUSATE SODIUM 100MG/10ML LIQUID
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300272
|
|
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
|
|
|
DOCUSATE SODIUM 100MG CAP
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
3300271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
DOCUSATE SODIUM 100MG CAP
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
3300271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
dog dander IgE REF602456
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
dog dander IgE REF602456
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
DOMICIL/REST HOME NEW PT HI-MOD SEVER 45
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 99326
|
| Hospital Charge Code |
8599326
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
DOMICIL/REST HOME NEW PT HI-MOD SEVER 45
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 99326
|
| Hospital Charge Code |
8599326
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
