|
EPIDRM AGRFT F/S/N/H/F/G/M/D GT EA 100CM
|
Facility
|
OP
|
$3,102.00
|
|
|
Service Code
|
CPT 15116
|
| Hospital Charge Code |
1999257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$2,946.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,861.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cigna Commercial |
$2,636.70
|
| Rate for Payer: First Health Commercial |
$2,791.80
|
| Rate for Payer: First Health Workers Compensation |
$1,197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,791.80
|
| Rate for Payer: GEHA Commercial |
$2,481.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,791.80
|
| Rate for Payer: Humana ChoiceCare |
$806.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$2,822.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,861.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,171.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,791.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,946.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,326.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,729.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,884.86
|
| Rate for Payer: Zelis Auto |
$1,240.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,551.00
|
| Rate for Payer: Zelis Worker's Compensation |
$846.85
|
|
|
EPIDRM AGRFT F/S/N/H/F/G/M/D GT EA 100CM
|
Facility
|
IP
|
$3,102.00
|
|
|
Service Code
|
CPT 15116
|
| Hospital Charge Code |
1999257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.85 |
| Max. Negotiated Rate |
$2,946.90 |
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cigna Commercial |
$2,636.70
|
| Rate for Payer: First Health Commercial |
$2,791.80
|
| Rate for Payer: First Health Workers Compensation |
$1,197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,791.80
|
| Rate for Payer: GEHA Commercial |
$2,171.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,791.80
|
| Rate for Payer: Multiplan All |
$2,822.82
|
| Rate for Payer: OMNI Networks Commercial |
$2,171.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,791.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,946.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,326.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,884.86
|
| Rate for Payer: Zelis Auto |
$1,240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$846.85
|
|
|
EPIDRM AGRFT TAL 1ST 100CM/&/1% BDY I/CH
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
6115110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.94 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: First Health Workers Compensation |
$552.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
| Rate for Payer: Zelis Worker's Compensation |
$390.94
|
|
|
EPIDRM AGRFT TAL 1ST 100CM/&/1% BDY I/CH
|
Facility
|
IP
|
$4,392.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
1999254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,199.02 |
| Max. Negotiated Rate |
$4,172.40 |
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$3,733.20
|
| Rate for Payer: First Health Commercial |
$3,952.80
|
| Rate for Payer: First Health Workers Compensation |
$1,695.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,952.80
|
| Rate for Payer: GEHA Commercial |
$3,074.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,952.80
|
| Rate for Payer: Multiplan All |
$3,996.72
|
| Rate for Payer: OMNI Networks Commercial |
$3,074.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,952.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,172.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,294.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,084.56
|
| Rate for Payer: Zelis Auto |
$1,756.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,199.02
|
|
|
EPIDRM AGRFT TAL 1ST 100CM/&/1% BDY I/CH
|
Facility
|
OP
|
$4,392.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
1999254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$4,172.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,635.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$3,733.20
|
| Rate for Payer: First Health Commercial |
$3,952.80
|
| Rate for Payer: First Health Workers Compensation |
$1,695.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,952.80
|
| Rate for Payer: GEHA Commercial |
$3,513.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,952.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$3,996.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,074.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,952.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,172.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$3,294.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,084.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,756.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,199.02
|
|
|
EPIDRM AGRFT TAL 1ST 100CM/&/1% BDY I/CH
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
6115110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: First Health Workers Compensation |
$552.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,145.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$572.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$390.94
|
|
|
EPIDRM AGRFT TAL EA 100CM/EA 1% BDY I/CH
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
CPT 15111
|
| Hospital Charge Code |
1999255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$899.26 |
| Max. Negotiated Rate |
$3,129.30 |
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$2,799.90
|
| Rate for Payer: First Health Commercial |
$2,964.60
|
| Rate for Payer: First Health Workers Compensation |
$1,271.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,964.60
|
| Rate for Payer: GEHA Commercial |
$2,305.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,964.60
|
| Rate for Payer: Multiplan All |
$2,997.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,305.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,964.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,129.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,470.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,063.42
|
| Rate for Payer: Zelis Auto |
$1,317.60
|
| Rate for Payer: Zelis Worker's Compensation |
$899.26
|
|
|
EPIDRM AGRFT TAL EA 100CM/EA 1% BDY I/CH
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
CPT 15111
|
| Hospital Charge Code |
1999255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$3,129.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,976.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$2,799.90
|
| Rate for Payer: First Health Commercial |
$2,964.60
|
| Rate for Payer: First Health Workers Compensation |
$1,271.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,964.60
|
| Rate for Payer: GEHA Commercial |
$2,635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,964.60
|
| Rate for Payer: Humana ChoiceCare |
$856.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$2,997.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,976.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,305.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,964.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,129.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,470.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,898.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,063.42
|
| Rate for Payer: Zelis Auto |
$1,317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,647.00
|
| Rate for Payer: Zelis Worker's Compensation |
$899.26
|
|
|
EPIDRM AGRFT TAL EA 100CM/EA 1% BDY I/CH
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 15111
|
| Hospital Charge Code |
6115111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
EPIDRM AGRFT TAL EA 100CM/EA 1% BDY I/CH
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 15111
|
| Hospital Charge Code |
6115111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$448.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Humana ChoiceCare |
$85.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$197.40
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.50
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
EPIDUROGOGPHY RAD SUPERVISON AND INTERPR
|
Facility
|
OP
|
$1,413.00
|
|
| Hospital Charge Code |
6172275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$353.25 |
| Max. Negotiated Rate |
$1,342.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$847.80
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$1,201.05
|
| Rate for Payer: First Health Commercial |
$1,271.70
|
| Rate for Payer: First Health Workers Compensation |
$545.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,271.70
|
| Rate for Payer: GEHA Commercial |
$1,130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,271.70
|
| Rate for Payer: Humana ChoiceCare |
$367.38
|
| Rate for Payer: Multiplan All |
$1,285.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$847.80
|
| Rate for Payer: OMNI Networks Commercial |
$989.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,271.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,342.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,243.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,314.09
|
| Rate for Payer: Zelis Auto |
$565.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$706.50
|
| Rate for Payer: Zelis Worker's Compensation |
$385.75
|
|
|
EPIDUROGOGPHY RAD SUPERVISON AND INTERPR
|
Facility
|
IP
|
$1,413.00
|
|
| Hospital Charge Code |
6172275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.75 |
| Max. Negotiated Rate |
$1,342.35 |
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$1,201.05
|
| Rate for Payer: First Health Commercial |
$1,271.70
|
| Rate for Payer: First Health Workers Compensation |
$545.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,271.70
|
| Rate for Payer: GEHA Commercial |
$989.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,271.70
|
| Rate for Payer: Multiplan All |
$1,285.83
|
| Rate for Payer: OMNI Networks Commercial |
$989.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,271.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,342.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,314.09
|
| Rate for Payer: Zelis Auto |
$565.20
|
| Rate for Payer: Zelis Worker's Compensation |
$385.75
|
|
|
EPINEPHrine 0.1 MG/ML INJ
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3300298
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$53.20 |
| 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 |
$21.62
|
| 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 |
$15.29
|
|
|
EPINEPHrine 0.1 MG/ML INJ
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3300298
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$21.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$49.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.29
|
|
|
EPINEPHrine INJ 10 MG/10 ML
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3300300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
EPINEPHrine INJ 10 MG/10 ML
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3300300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
EPINEPHrine SQ/IM INJ - 1MG/ML
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3300299
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$66.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
EPINEPHrine SQ/IM INJ - 1MG/ML
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3300299
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$76.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$24.70
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.00
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
6159300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: First Health Workers Compensation |
$181.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$128.04
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
6159300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: First Health Workers Compensation |
$181.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Worker's Compensation |
$128.04
|
|
|
EPOETIN ALFA INJ 10000 UNITS/ML
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
EPOETIN ALFA INJ 10000 UNITS/ML
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$612.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
EPOETIN ALFA INJ 20000 UNITS/ML
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$1,422.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$898.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cigna Commercial |
$1,272.45
|
| Rate for Payer: First Health Commercial |
$1,347.30
|
| Rate for Payer: First Health Workers Compensation |
$577.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,347.30
|
| Rate for Payer: GEHA Commercial |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,347.30
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$1,362.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,047.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,347.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,422.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,122.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,392.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$598.80
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$408.68
|
|
|
EPOETIN ALFA INJ 20000 UNITS/ML
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.68 |
| Max. Negotiated Rate |
$1,422.15 |
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cigna Commercial |
$1,272.45
|
| Rate for Payer: First Health Commercial |
$1,347.30
|
| Rate for Payer: First Health Workers Compensation |
$577.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,347.30
|
| Rate for Payer: GEHA Commercial |
$1,047.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,347.30
|
| Rate for Payer: Multiplan All |
$1,362.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,047.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,347.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,422.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,122.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,392.21
|
| Rate for Payer: Zelis Auto |
$598.80
|
| Rate for Payer: Zelis Worker's Compensation |
$408.68
|
|
|
EPOETIN ALFA INJ 3000 UNITS/ML
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$40.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$28.39
|
|
