|
FREE T4 (Vitros)
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
2232249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$14.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$110.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.36
|
|
|
FREE T4 (Vitros)
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
2232249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$14.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$126.40
|
| Rate for Payer: GEHA Medicare |
$9.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Humana ChoiceCare |
$9.92
|
| Rate for Payer: Humana Medicare Advantage |
$9.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.02
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.33
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.04
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$134.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.02
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Medicare |
$7.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.82
|
| Rate for Payer: Zelis Worker's Compensation |
$10.36
|
|
|
FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
6154164
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$421.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
9200013
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$421.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
6154164
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
9200013
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
fructosamine REF100800
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
2299665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.76
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$30.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$16.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$18.44
|
| Rate for Payer: Humana Medicare Advantage |
$16.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.76
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.49
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.52
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.42
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.76
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$14.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.11
|
| Rate for Payer: Zelis Worker's Compensation |
$21.23
|
|
|
fructosamine REF100800
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
2299665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$30.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.23
|
|
|
FSBG
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
8182962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$4.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.30
|
|
|
FSBG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
8182962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$4.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: GEHA Medicare |
$3.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$3.61
|
| Rate for Payer: Humana Medicare Advantage |
$3.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.28
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.58
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6.56
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$43.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.28
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Medicare |
$2.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.94
|
| Rate for Payer: Zelis Worker's Compensation |
$3.30
|
|
|
fsh REF004309
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
2233001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.34 |
| 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 |
$33.01
|
| 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 |
$23.34
|
|
|
fsh REF004309
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
2233001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.45
|
| 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 |
$33.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.58
|
| 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 |
$33.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$133.60
|
| Rate for Payer: GEHA Medicare |
$18.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Humana ChoiceCare |
$20.44
|
| Rate for Payer: Humana Medicare Advantage |
$18.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.58
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.59
|
| 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 |
$31.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.16
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.21
|
| Rate for Payer: United Healthcare Commercial |
$141.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.58
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Medicare |
$15.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.30
|
| Rate for Payer: Zelis Worker's Compensation |
$23.34
|
|
|
F/U EVAL DIABETIC PT W/LOPS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT G0246
|
| Hospital Charge Code |
8700246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
F/U EVAL DIABETIC PT W/LOPS
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT G0246
|
| Hospital Charge Code |
8700246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$84.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$97.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$84.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
F/U EVAL DIABETIC PT W/LOPS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT G0246
|
| Hospital Charge Code |
9600246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
F/U EVAL DIABETIC PT W/LOPS
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT G0246
|
| Hospital Charge Code |
9600246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$84.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$97.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$84.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
F/U EVAL DIABETIC PT W/LOPS
|
Facility
|
OP
|
$106.74
|
|
|
Service Code
|
CPT G0246
|
| Hospital Charge Code |
8500246
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$90.73
|
| Rate for Payer: First Health Commercial |
$96.07
|
| Rate for Payer: First Health Workers Compensation |
$41.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.07
|
| Rate for Payer: GEHA Commercial |
$85.39
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.07
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$84.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$97.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$74.72
|
| Rate for Payer: One Health Plan PPO/POS |
$96.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$97.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$84.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$80.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$42.70
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$29.14
|
|
|
F/U EVAL DIABETIC PT W/LOPS
|
Facility
|
IP
|
$106.74
|
|
|
Service Code
|
CPT G0246
|
| Hospital Charge Code |
8500246
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$90.73
|
| Rate for Payer: First Health Commercial |
$96.07
|
| Rate for Payer: First Health Workers Compensation |
$41.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.07
|
| Rate for Payer: GEHA Commercial |
$74.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.07
|
| Rate for Payer: Multiplan All |
$97.13
|
| Rate for Payer: OMNI Networks Commercial |
$74.72
|
| Rate for Payer: One Health Plan PPO/POS |
$96.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.40
|
| Rate for Payer: Three Rivers Provider Network All |
$80.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.27
|
| Rate for Payer: Zelis Auto |
$42.70
|
| Rate for Payer: Zelis Worker's Compensation |
$29.14
|
|
|
fungal stain REF008136
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
22990347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$53.55
|
| Rate for Payer: First Health Commercial |
$56.70
|
| Rate for Payer: First Health Workers Compensation |
$10.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$56.70
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: GEHA Medicare |
$5.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$56.70
|
| Rate for Payer: Humana ChoiceCare |
$5.93
|
| Rate for Payer: Humana Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.39
|
| Rate for Payer: Multiplan All |
$57.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.16
|
| Rate for Payer: OMNI Networks Commercial |
$44.10
|
| Rate for Payer: One Health Plan PPO/POS |
$56.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$59.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.78
|
| Rate for Payer: Three Rivers Provider Network All |
$47.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$53.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$58.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.39
|
| Rate for Payer: Zelis Auto |
$25.20
|
| Rate for Payer: Zelis Medicare |
$4.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.47
|
| Rate for Payer: Zelis Worker's Compensation |
$7.52
|
|
|
fungal stain REF008136
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
22990347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$53.55
|
| Rate for Payer: First Health Commercial |
$56.70
|
| Rate for Payer: First Health Workers Compensation |
$10.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$56.70
|
| Rate for Payer: GEHA Commercial |
$44.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$56.70
|
| Rate for Payer: Multiplan All |
$57.33
|
| Rate for Payer: OMNI Networks Commercial |
$44.10
|
| Rate for Payer: One Health Plan PPO/POS |
$56.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$59.85
|
| Rate for Payer: Three Rivers Provider Network All |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$58.59
|
| Rate for Payer: Zelis Auto |
$25.20
|
| Rate for Payer: Zelis Worker's Compensation |
$7.52
|
|
|
FUROSEMIDE 100 MG/ 10 ML (IV DRIP ONLY)
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT J1938
|
| Hospital Charge Code |
3302829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$0.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
FUROSEMIDE 100 MG/ 10 ML (IV DRIP ONLY)
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT J1938
|
| Hospital Charge Code |
3302829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
FUROSEMIDE 20MG/2ML INJECTION
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT J1938
|
| Hospital Charge Code |
3300365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| 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: 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 |
$0.02
|
| 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
|
|
|
FUROSEMIDE 20MG/2ML INJECTION
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT J1938
|
| Hospital Charge Code |
3300365
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
FUROSEMIDE 20MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3300368
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
