|
fibrinogen activity REF001610
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
22990734
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$14.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$116.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.15
|
|
|
fibrinogen activity REF001610
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
22990734
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$14.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$133.60
|
| Rate for Payer: GEHA Medicare |
$9.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Humana ChoiceCare |
$10.69
|
| Rate for Payer: Humana Medicare Advantage |
$9.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.72
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.52
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.44
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.53
|
| Rate for Payer: United Healthcare Commercial |
$141.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.72
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Medicare |
$8.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.66
|
| Rate for Payer: Zelis Worker's Compensation |
$10.15
|
|
|
fibrosure hcv REF550123
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
2200612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$82.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.46
|
|
|
fibrosure hcv REF550123
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
2200612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$108.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$108.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$85.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$72.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$82.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: GEHA Medicare |
$72.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$79.41
|
| Rate for Payer: Humana Medicare Advantage |
$72.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$121.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$87.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$72.19
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$122.72
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$101.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$87.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$72.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$144.38
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$386.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$72.19
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$61.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.63
|
| Rate for Payer: Zelis Worker's Compensation |
$58.46
|
|
|
FIBULA BONE GRAFT MICROVASC
|
Facility
|
IP
|
$5,190.00
|
|
|
Service Code
|
CPT 20955
|
| Hospital Charge Code |
6120955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,416.87 |
| Max. Negotiated Rate |
$4,930.50 |
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$4,411.50
|
| Rate for Payer: First Health Commercial |
$4,671.00
|
| Rate for Payer: First Health Workers Compensation |
$2,003.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,671.00
|
| Rate for Payer: GEHA Commercial |
$3,633.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,671.00
|
| Rate for Payer: Multiplan All |
$4,722.90
|
| Rate for Payer: OMNI Networks Commercial |
$3,633.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,671.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,930.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,892.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,826.70
|
| Rate for Payer: Zelis Auto |
$2,076.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,416.87
|
|
|
FIBULA BONE GRAFT MICROVASC
|
Facility
|
OP
|
$5,190.00
|
|
|
Service Code
|
CPT 20955
|
| Hospital Charge Code |
6120955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,297.50 |
| Max. Negotiated Rate |
$4,930.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,114.00
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$4,411.50
|
| Rate for Payer: First Health Commercial |
$4,671.00
|
| Rate for Payer: First Health Workers Compensation |
$2,003.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,671.00
|
| Rate for Payer: GEHA Commercial |
$4,152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,671.00
|
| Rate for Payer: Humana ChoiceCare |
$1,349.40
|
| Rate for Payer: Multiplan All |
$4,722.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,114.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,633.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,671.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,930.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,892.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,567.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,297.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,826.70
|
| Rate for Payer: Zelis Auto |
$2,076.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,595.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,416.87
|
|
|
FIDAXOMICIN 200MG
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
3302524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.50 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$600.10
|
| Rate for Payer: First Health Commercial |
$635.40
|
| Rate for Payer: First Health Workers Compensation |
$272.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$635.40
|
| Rate for Payer: GEHA Commercial |
$564.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$635.40
|
| Rate for Payer: Humana ChoiceCare |
$183.56
|
| Rate for Payer: Multiplan All |
$642.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$423.60
|
| Rate for Payer: OMNI Networks Commercial |
$494.20
|
| Rate for Payer: One Health Plan PPO/POS |
$635.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$670.70
|
| Rate for Payer: Three Rivers Provider Network All |
$529.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$176.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$656.58
|
| Rate for Payer: Zelis Auto |
$282.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$353.00
|
| Rate for Payer: Zelis Worker's Compensation |
$192.74
|
|
|
FIDAXOMICIN 200MG
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
3302524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.74 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$600.10
|
| Rate for Payer: First Health Commercial |
$635.40
|
| Rate for Payer: First Health Workers Compensation |
$272.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$635.40
|
| Rate for Payer: GEHA Commercial |
$494.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$635.40
|
| Rate for Payer: Multiplan All |
$642.46
|
| Rate for Payer: OMNI Networks Commercial |
$494.20
|
| Rate for Payer: One Health Plan PPO/POS |
$635.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$670.70
|
| Rate for Payer: Three Rivers Provider Network All |
$529.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$656.58
|
| Rate for Payer: Zelis Auto |
$282.40
|
| Rate for Payer: Zelis Worker's Compensation |
$192.74
|
|
|
FILGRASTIM 300 MCG/ML VIAL
|
Facility
|
OP
|
$2,934.00
|
|
|
Service Code
|
CPT J1442
|
| Hospital Charge Code |
3300340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2,787.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,760.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cigna Commercial |
$2,493.90
|
| Rate for Payer: First Health Commercial |
$2,640.60
|
| Rate for Payer: First Health Workers Compensation |
$1,132.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,640.60
|
| Rate for Payer: GEHA Commercial |
$1.10
|
| Rate for Payer: GEHA Medicare |
$1.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,640.60
|
| Rate for Payer: Humana ChoiceCare |
$1.10
|
| Rate for Payer: Humana Medicare Advantage |
$1.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1.00
|
| Rate for Payer: Multiplan All |
$2,669.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,053.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,640.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,787.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,200.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,728.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1.00
|
| Rate for Payer: Zelis Auto |
$1,173.60
|
| Rate for Payer: Zelis Medicare |
$0.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$800.98
|
|
|
FILGRASTIM 300 MCG/ML VIAL
|
Facility
|
IP
|
$2,934.00
|
|
|
Service Code
|
CPT J1442
|
| Hospital Charge Code |
3300340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$800.98 |
| Max. Negotiated Rate |
$2,787.30 |
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cigna Commercial |
$2,493.90
|
| Rate for Payer: First Health Commercial |
$2,640.60
|
| Rate for Payer: First Health Workers Compensation |
$1,132.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,640.60
|
| Rate for Payer: GEHA Commercial |
$2,053.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,640.60
|
| Rate for Payer: Multiplan All |
$2,669.94
|
| Rate for Payer: OMNI Networks Commercial |
$2,053.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,640.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,787.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,200.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,728.62
|
| Rate for Payer: Zelis Auto |
$1,173.60
|
| Rate for Payer: Zelis Worker's Compensation |
$800.98
|
|
|
FILGRASTIM 480MCG/1.6ML VIAL
|
Facility
|
IP
|
$3,470.00
|
|
|
Service Code
|
CPT J1442
|
| Hospital Charge Code |
3300341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$947.31 |
| Max. Negotiated Rate |
$3,296.50 |
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$2,949.50
|
| Rate for Payer: First Health Commercial |
$3,123.00
|
| Rate for Payer: First Health Workers Compensation |
$1,339.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,123.00
|
| Rate for Payer: GEHA Commercial |
$2,429.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,123.00
|
| Rate for Payer: Multiplan All |
$3,157.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,429.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,123.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,296.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,602.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,227.10
|
| Rate for Payer: Zelis Auto |
$1,388.00
|
| Rate for Payer: Zelis Worker's Compensation |
$947.31
|
|
|
FILGRASTIM 480MCG/1.6ML VIAL
|
Facility
|
OP
|
$3,470.00
|
|
|
Service Code
|
CPT J1442
|
| Hospital Charge Code |
3300341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3,296.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,082.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$2,949.50
|
| Rate for Payer: First Health Commercial |
$3,123.00
|
| Rate for Payer: First Health Workers Compensation |
$1,339.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,123.00
|
| Rate for Payer: GEHA Commercial |
$1.10
|
| Rate for Payer: GEHA Medicare |
$1.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,123.00
|
| Rate for Payer: Humana ChoiceCare |
$1.10
|
| Rate for Payer: Humana Medicare Advantage |
$1.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1.00
|
| Rate for Payer: Multiplan All |
$3,157.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,429.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,123.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,296.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,602.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.98
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,227.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1.00
|
| Rate for Payer: Zelis Auto |
$1,388.00
|
| Rate for Payer: Zelis Medicare |
$0.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$947.31
|
|
|
FILLETED FINGER/TOE FLAP
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 14350
|
| Hospital Charge Code |
6114350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,207.00
|
| Rate for Payer: First Health Commercial |
$1,278.00
|
| Rate for Payer: First Health Workers Compensation |
$548.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.00
|
| Rate for Payer: GEHA Commercial |
$1,136.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.00
|
| 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 |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,292.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$994.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,320.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$568.00
|
| 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 |
$387.66
|
|
|
FILLETED FINGER/TOE FLAP
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 14350
|
| Hospital Charge Code |
6114350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,207.00
|
| Rate for Payer: First Health Commercial |
$1,278.00
|
| Rate for Payer: First Health Workers Compensation |
$548.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.00
|
| Rate for Payer: GEHA Commercial |
$994.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.00
|
| Rate for Payer: Multiplan All |
$1,292.20
|
| Rate for Payer: OMNI Networks Commercial |
$994.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,320.60
|
| Rate for Payer: Zelis Auto |
$568.00
|
| Rate for Payer: Zelis Worker's Compensation |
$387.66
|
|
|
FILSHIE CLIP
|
Facility
|
OP
|
$836.50
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7007063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$794.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$501.90
|
| Rate for Payer: Cash Price |
$501.90
|
| Rate for Payer: Cash Price |
$501.90
|
| Rate for Payer: Cigna Commercial |
$711.02
|
| Rate for Payer: First Health Commercial |
$752.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.85
|
| Rate for Payer: GEHA Commercial |
$669.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.85
|
| Rate for Payer: Humana ChoiceCare |
$217.49
|
| Rate for Payer: Multiplan All |
$761.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$501.90
|
| Rate for Payer: OMNI Networks Commercial |
$585.55
|
| Rate for Payer: One Health Plan PPO/POS |
$752.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.67
|
| Rate for Payer: Three Rivers Provider Network All |
$627.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$736.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.95
|
| Rate for Payer: Zelis Auto |
$334.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$418.25
|
|
|
FILSHIE CLIP
|
Facility
|
IP
|
$836.50
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7007063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.60 |
| Max. Negotiated Rate |
$794.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.20
|
| Rate for Payer: Cash Price |
$501.90
|
| Rate for Payer: Cash Price |
$501.90
|
| Rate for Payer: Cigna Commercial |
$711.02
|
| Rate for Payer: First Health Commercial |
$752.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.85
|
| Rate for Payer: GEHA Commercial |
$585.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.85
|
| Rate for Payer: Multiplan All |
$761.22
|
| Rate for Payer: OMNI Networks Commercial |
$585.55
|
| Rate for Payer: One Health Plan PPO/POS |
$752.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.67
|
| Rate for Payer: Three Rivers Provider Network All |
$627.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.95
|
| Rate for Payer: Zelis Auto |
$334.60
|
|
|
FILSHIE CLIP APPLIER
|
Facility
|
IP
|
$2,024.72
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7007062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.89 |
| Max. Negotiated Rate |
$1,923.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,619.78
|
| Rate for Payer: Cash Price |
$1,214.83
|
| Rate for Payer: Cash Price |
$1,214.83
|
| Rate for Payer: Cigna Commercial |
$1,721.01
|
| Rate for Payer: First Health Commercial |
$1,822.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,822.25
|
| Rate for Payer: GEHA Commercial |
$1,417.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,822.25
|
| Rate for Payer: Multiplan All |
$1,842.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,417.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,822.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,923.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,518.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,882.99
|
| Rate for Payer: Zelis Auto |
$809.89
|
|
|
FILSHIE CLIP APPLIER
|
Facility
|
OP
|
$2,024.72
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7007062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.18 |
| Max. Negotiated Rate |
$1,923.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,214.83
|
| Rate for Payer: Cash Price |
$1,214.83
|
| Rate for Payer: Cash Price |
$1,214.83
|
| Rate for Payer: Cigna Commercial |
$1,721.01
|
| Rate for Payer: First Health Commercial |
$1,822.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,822.25
|
| Rate for Payer: GEHA Commercial |
$1,619.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,822.25
|
| Rate for Payer: Humana ChoiceCare |
$526.43
|
| Rate for Payer: Multiplan All |
$1,842.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,214.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,417.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,822.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,923.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,518.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,781.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$506.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,882.99
|
| Rate for Payer: Zelis Auto |
$809.89
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,012.36
|
|
|
FILTER, NON DISPOSABLE W PAP
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT A7039
|
| Hospital Charge Code |
3000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$4.68
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.80
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
FILTER, NON DISPOSABLE W PAP
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT A7039
|
| Hospital Charge Code |
3000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
FINASTERIDE 5MG TAB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
3300342
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
FINASTERIDE 5MG TAB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
3300342
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$6.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.00
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
FINE NEEDLE ADDITIONAL LESIONS US GUIDE
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
7778511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$1,517.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.20
|
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cigna Commercial |
$1,357.45
|
| Rate for Payer: First Health Commercial |
$1,437.30
|
| Rate for Payer: First Health Workers Compensation |
$180.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,437.30
|
| Rate for Payer: GEHA Commercial |
$1,277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,437.30
|
| Rate for Payer: Humana ChoiceCare |
$415.22
|
| Rate for Payer: Multiplan All |
$1,453.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$958.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,437.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,517.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,405.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$399.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,485.21
|
| Rate for Payer: Zelis Auto |
$638.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$798.50
|
| Rate for Payer: Zelis Worker's Compensation |
$127.32
|
|
|
FINE NEEDLE ADDITIONAL LESIONS US GUIDE
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
7778511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$435.98 |
| Max. Negotiated Rate |
$1,517.15 |
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cigna Commercial |
$1,357.45
|
| Rate for Payer: First Health Commercial |
$1,437.30
|
| Rate for Payer: First Health Workers Compensation |
$616.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,437.30
|
| Rate for Payer: GEHA Commercial |
$1,117.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,437.30
|
| Rate for Payer: Multiplan All |
$1,453.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,437.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,517.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,485.21
|
| Rate for Payer: Zelis Auto |
$638.80
|
| Rate for Payer: Zelis Worker's Compensation |
$435.98
|
|
|
FINE NEEDLE ASPIRATION BIOPSY, WITHOUT IMAGING GUIDANCE; FIRST LESION
|
Facility
|
OP
|
$758.74
|
|
|
Service Code
|
CPT 10021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$152.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$152.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$121.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: First Health Workers Compensation |
$488.25
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$123.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$142.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$123.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$345.23
|
|
