|
fecal fat qual REF001677
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
2205964
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$9.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$132.00
|
| Rate for Payer: GEHA Medicare |
$5.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$5.61
|
| Rate for Payer: Humana Medicare Advantage |
$5.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.10
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.67
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.20
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$140.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.10
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Medicare |
$4.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.12
|
| Rate for Payer: Zelis Worker's Compensation |
$6.75
|
|
|
fecal fat quant 72hrs REF001354
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
2200437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$30.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$21.70
|
|
|
fecal fat quant 72hrs REF001354
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
2200437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$30.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$18.48
|
| Rate for Payer: Humana Medicare Advantage |
$16.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.80
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.56
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.60
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.80
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$14.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.16
|
| Rate for Payer: Zelis Worker's Compensation |
$21.70
|
|
|
fecal pancreatic elastase REF123234
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
fecal pancreatic elastase REF123234
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
FECAL WBC LACTOFERIN AGH
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
2299370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.46
|
| 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 |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.70
|
| 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 |
$27.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$19.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$21.67
|
| Rate for Payer: Humana Medicare Advantage |
$19.70
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$33.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.70
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.49
|
| 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 |
$33.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.40
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.31
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.70
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$16.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.64
|
| Rate for Payer: Zelis Worker's Compensation |
$19.75
|
|
|
FECAL WBC LACTOFERIN AGH
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
2299370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$131.10 |
| 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 |
$27.93
|
| 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 |
$19.75
|
|
|
FELODIPINE 2.5MG SR 24HR TAB
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 00603358121
|
| Hospital Charge Code |
3300322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
FELODIPINE 2.5MG SR 24HR TAB
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 00603358121
|
| Hospital Charge Code |
3300322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
FELODIPINE 5MG SR 24HR TAB
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 00603358221
|
| Hospital Charge Code |
3300323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
FELODIPINE 5MG SR 24HR TAB
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 00603358221
|
| Hospital Charge Code |
3300323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
FEMORAL DISTAL AUGMENT
|
Facility
|
OP
|
$6,248.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.00 |
| Max. Negotiated Rate |
$5,935.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,748.80
|
| Rate for Payer: Cash Price |
$3,748.80
|
| Rate for Payer: Cash Price |
$3,748.80
|
| Rate for Payer: Cigna Commercial |
$5,310.80
|
| Rate for Payer: First Health Commercial |
$5,623.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,623.20
|
| Rate for Payer: GEHA Commercial |
$4,998.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,623.20
|
| Rate for Payer: Humana ChoiceCare |
$1,624.48
|
| Rate for Payer: Multiplan All |
$5,685.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,748.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,373.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,623.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,935.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,686.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,498.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,562.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,810.64
|
| Rate for Payer: Zelis Auto |
$2,499.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.00
|
|
|
FEMORAL DISTAL AUGMENT
|
Facility
|
OP
|
$3,732.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.00 |
| Max. Negotiated Rate |
$3,545.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna Commercial |
$3,172.20
|
| Rate for Payer: First Health Commercial |
$3,358.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,358.80
|
| Rate for Payer: GEHA Commercial |
$2,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,358.80
|
| Rate for Payer: Humana ChoiceCare |
$970.32
|
| Rate for Payer: Multiplan All |
$3,396.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,239.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,612.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,358.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,545.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,284.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,470.76
|
| Rate for Payer: Zelis Auto |
$1,492.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,866.00
|
|
|
FEMORAL DISTAL AUGMENT
|
Facility
|
IP
|
$3,732.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.80 |
| Max. Negotiated Rate |
$3,545.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna Commercial |
$3,172.20
|
| Rate for Payer: First Health Commercial |
$3,358.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,358.80
|
| Rate for Payer: GEHA Commercial |
$2,612.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,358.80
|
| Rate for Payer: Multiplan All |
$3,396.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,612.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,358.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,545.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,799.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,470.76
|
| Rate for Payer: Zelis Auto |
$1,492.80
|
|
|
FEMORAL DISTAL AUGMENT
|
Facility
|
IP
|
$6,248.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.20 |
| Max. Negotiated Rate |
$5,935.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,998.40
|
| Rate for Payer: Cash Price |
$3,748.80
|
| Rate for Payer: Cash Price |
$3,748.80
|
| Rate for Payer: Cigna Commercial |
$5,310.80
|
| Rate for Payer: First Health Commercial |
$5,623.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,623.20
|
| Rate for Payer: GEHA Commercial |
$4,373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,623.20
|
| Rate for Payer: Multiplan All |
$5,685.68
|
| Rate for Payer: OMNI Networks Commercial |
$4,373.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,623.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,935.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,686.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,810.64
|
| Rate for Payer: Zelis Auto |
$2,499.20
|
|
|
FEM/POPL REVASC STNT & ATHER
|
Facility
|
OP
|
$2,372.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
6137227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$647.56 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,403.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,423.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,403.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16,163.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cigna Commercial |
$2,016.20
|
| Rate for Payer: First Health Commercial |
$2,134.80
|
| Rate for Payer: First Health Workers Compensation |
$915.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,134.80
|
| Rate for Payer: GEHA Commercial |
$1,897.60
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,134.80
|
| Rate for Payer: Humana ChoiceCare |
$18,755.68
|
| Rate for Payer: Humana Medicare Advantage |
$17,050.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,645.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,492.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$2,158.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,660.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,134.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,042.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,492.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,253.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,779.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,492.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,205.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$948.80
|
| Rate for Payer: Zelis Medicare |
$14,493.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,460.74
|
| Rate for Payer: Zelis Worker's Compensation |
$647.56
|
|
|
FEM/POPL REVASC STNT & ATHER
|
Facility
|
IP
|
$2,372.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
6137227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$647.56 |
| Max. Negotiated Rate |
$2,253.40 |
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cigna Commercial |
$2,016.20
|
| Rate for Payer: First Health Commercial |
$2,134.80
|
| Rate for Payer: First Health Workers Compensation |
$915.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,134.80
|
| Rate for Payer: GEHA Commercial |
$1,660.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,134.80
|
| Rate for Payer: Multiplan All |
$2,158.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,660.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,134.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,253.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,779.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,205.96
|
| Rate for Payer: Zelis Auto |
$948.80
|
| Rate for Payer: Zelis Worker's Compensation |
$647.56
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
OP
|
$1,702.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
6137226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$464.65 |
| Max. Negotiated Rate |
$21,536.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,021.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,332.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,768.32
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$1,446.70
|
| Rate for Payer: First Health Commercial |
$1,531.80
|
| Rate for Payer: First Health Workers Compensation |
$657.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,531.80
|
| Rate for Payer: GEHA Commercial |
$1,361.60
|
| Rate for Payer: GEHA Medicare |
$10,768.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,531.80
|
| Rate for Payer: Humana ChoiceCare |
$11,845.15
|
| Rate for Payer: Humana Medicare Advantage |
$10,768.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18,090.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,522.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,768.32
|
| Rate for Payer: Multiplan All |
$1,548.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18,306.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,191.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,531.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,995.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,522.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,768.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,616.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21,536.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,276.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,552.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,522.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,768.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,582.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10,768.32
|
| Rate for Payer: Zelis Auto |
$680.80
|
| Rate for Payer: Zelis Medicare |
$9,153.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,921.98
|
| Rate for Payer: Zelis Worker's Compensation |
$464.65
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
IP
|
$1,702.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
6137226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$464.65 |
| Max. Negotiated Rate |
$1,616.90 |
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$1,446.70
|
| Rate for Payer: First Health Commercial |
$1,531.80
|
| Rate for Payer: First Health Workers Compensation |
$657.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,531.80
|
| Rate for Payer: GEHA Commercial |
$1,191.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,531.80
|
| Rate for Payer: Multiplan All |
$1,548.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,191.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,531.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,616.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,276.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,582.86
|
| Rate for Payer: Zelis Auto |
$680.80
|
| Rate for Payer: Zelis Worker's Compensation |
$464.65
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
IP
|
$1,972.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
6137225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$538.36 |
| Max. Negotiated Rate |
$1,873.40 |
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$1,676.20
|
| Rate for Payer: First Health Commercial |
$1,774.80
|
| Rate for Payer: First Health Workers Compensation |
$761.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,774.80
|
| Rate for Payer: GEHA Commercial |
$1,380.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,774.80
|
| Rate for Payer: Multiplan All |
$1,794.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,380.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,774.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,873.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,479.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,833.96
|
| Rate for Payer: Zelis Auto |
$788.80
|
| Rate for Payer: Zelis Worker's Compensation |
$538.36
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
OP
|
$1,972.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
6137225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$538.36 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,183.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,332.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$1,676.20
|
| Rate for Payer: First Health Commercial |
$1,774.80
|
| Rate for Payer: First Health Workers Compensation |
$761.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,774.80
|
| Rate for Payer: GEHA Commercial |
$1,577.60
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,774.80
|
| Rate for Payer: Humana ChoiceCare |
$18,755.68
|
| Rate for Payer: Humana Medicare Advantage |
$17,050.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,645.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,522.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$1,794.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,380.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,774.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,995.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,522.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,873.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,479.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,522.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,833.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$788.80
|
| Rate for Payer: Zelis Medicare |
$14,493.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,460.74
|
| Rate for Payer: Zelis Worker's Compensation |
$538.36
|
|
|
FEM/POPL REVAS W/TLA
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
6137224
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.58 |
| Max. Negotiated Rate |
$1,376.55 |
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Cigna Commercial |
$1,231.65
|
| Rate for Payer: First Health Commercial |
$1,304.10
|
| Rate for Payer: First Health Workers Compensation |
$559.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,304.10
|
| Rate for Payer: GEHA Commercial |
$1,014.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,304.10
|
| Rate for Payer: Multiplan All |
$1,318.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,014.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,304.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,376.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,347.57
|
| Rate for Payer: Zelis Auto |
$579.60
|
| Rate for Payer: Zelis Worker's Compensation |
$395.58
|
|
|
FEM/POPL REVAS W/TLA
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
6137224
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.58 |
| Max. Negotiated Rate |
$10,827.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$869.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,413.82
|
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Cigna Commercial |
$1,231.65
|
| Rate for Payer: First Health Commercial |
$1,304.10
|
| Rate for Payer: First Health Workers Compensation |
$559.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,304.10
|
| Rate for Payer: GEHA Commercial |
$1,159.20
|
| Rate for Payer: GEHA Medicare |
$5,413.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,304.10
|
| Rate for Payer: Humana ChoiceCare |
$5,955.20
|
| Rate for Payer: Humana Medicare Advantage |
$5,413.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,095.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,413.82
|
| Rate for Payer: Multiplan All |
$1,318.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,203.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,014.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,304.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,413.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,376.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,827.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,305.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,413.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,347.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,413.82
|
| Rate for Payer: Zelis Auto |
$579.60
|
| Rate for Payer: Zelis Medicare |
$4,601.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,496.58
|
| Rate for Payer: Zelis Worker's Compensation |
$395.58
|
|
|
FENOFIBRATE 145 MG TAB
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
3302924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
FENOFIBRATE 145 MG TAB
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
3302924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
