|
GADAVIST 7.5ML SYRINGE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT A9585
|
| Hospital Charge Code |
3301460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$183.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$0.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Humana ChoiceCare |
$123.76
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$285.60
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$418.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$129.95
|
|
|
GADAVIST 7.5ML SYRINGE
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT A9585
|
| Hospital Charge Code |
3301460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$183.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$333.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Worker's Compensation |
$129.95
|
|
|
GADOBENATE IV SOLN 20ML VIAL
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
3300373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$322.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
GADOBENATE IV SOLN 20ML VIAL
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
3300373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$1.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Humana ChoiceCare |
$119.60
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.00
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$404.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$230.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
GADOLINIUM INJ PER ML
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
2401010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$1.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
GADOLINIUM INJ PER ML
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
2401010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$23.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
galectin-3 REF004110
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82777
|
| Hospital Charge Code |
2200736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$79.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$79.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$44.25
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$50.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: GEHA Medicare |
$44.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Humana ChoiceCare |
$48.67
|
| Rate for Payer: Humana Medicare Advantage |
$44.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$74.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$64.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$44.25
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$75.22
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$74.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$64.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$44.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$88.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$43.37
|
| Rate for Payer: United Healthcare Commercial |
$229.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$44.25
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Medicare |
$37.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.10
|
| Rate for Payer: Zelis Worker's Compensation |
$35.45
|
|
|
galectin-3 REF004110
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82777
|
| Hospital Charge Code |
2200736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$50.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Worker's Compensation |
$35.45
|
|
|
GALVESTON METACARPAL BRACE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8230085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
|
|
GALVESTON METACARPAL BRACE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8230085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$138.34
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$141.16
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.80
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$162.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$141.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.50
|
|
|
GALVESTON METACARPAL BRACE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8800027
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
|
|
GALVESTON METACARPAL BRACE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8800027
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$138.34
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$141.16
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.80
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$162.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$141.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.50
|
|
|
GAMMAGARD LIQUID 10% 1 GM / 10 ML
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
3302880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.71 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$230.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$417.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Worker's Compensation |
$162.71
|
|
|
GAMMAGARD LIQUID 10% 1 GM / 10 ML
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
3302880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$45.31
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$230.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$49.84
|
| Rate for Payer: GEHA Medicare |
$45.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Humana ChoiceCare |
$49.84
|
| Rate for Payer: Humana Medicare Advantage |
$45.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$76.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$45.31
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$77.03
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$54.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$47.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$45.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$90.62
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$45.31
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Medicare |
$38.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.37
|
| Rate for Payer: Zelis Worker's Compensation |
$162.71
|
|
|
GAMMAGARD LIQUID 10% 5 GM/50 ML
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
3302852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$950.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$45.31
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: First Health Commercial |
$1,425.60
|
| Rate for Payer: First Health Workers Compensation |
$611.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,425.60
|
| Rate for Payer: GEHA Commercial |
$49.84
|
| Rate for Payer: GEHA Medicare |
$45.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,425.60
|
| Rate for Payer: Humana ChoiceCare |
$49.84
|
| Rate for Payer: Humana Medicare Advantage |
$45.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$76.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$45.31
|
| Rate for Payer: Multiplan All |
$1,441.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$77.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,108.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,425.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$54.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$47.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$45.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,504.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$90.62
|
| Rate for Payer: Three Rivers Provider Network All |
$1,188.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,473.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$45.31
|
| Rate for Payer: Zelis Auto |
$633.60
|
| Rate for Payer: Zelis Medicare |
$38.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.37
|
| Rate for Payer: Zelis Worker's Compensation |
$432.43
|
|
|
GAMMAGARD LIQUID 10% 5 GM/50 ML
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
3302852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.43 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: First Health Commercial |
$1,425.60
|
| Rate for Payer: First Health Workers Compensation |
$611.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,425.60
|
| Rate for Payer: GEHA Commercial |
$1,108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,425.60
|
| Rate for Payer: Multiplan All |
$1,441.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,108.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,425.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,504.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,188.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,473.12
|
| Rate for Payer: Zelis Auto |
$633.60
|
| Rate for Payer: Zelis Worker's Compensation |
$432.43
|
|
|
GAMUNEX-C 10% 10 GM/100 ML IV SOLN
|
Facility
|
IP
|
$3,548.00
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
3302881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$968.60 |
| Max. Negotiated Rate |
$3,370.60 |
| Rate for Payer: Cash Price |
$2,128.80
|
| Rate for Payer: Cigna Commercial |
$3,015.80
|
| Rate for Payer: First Health Commercial |
$3,193.20
|
| Rate for Payer: First Health Workers Compensation |
$1,369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,193.20
|
| Rate for Payer: GEHA Commercial |
$2,483.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,193.20
|
| Rate for Payer: Multiplan All |
$3,228.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,483.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,193.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,370.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,299.64
|
| Rate for Payer: Zelis Auto |
$1,419.20
|
| Rate for Payer: Zelis Worker's Compensation |
$968.60
|
|
|
GAMUNEX-C 10% 10 GM/100 ML IV SOLN
|
Facility
|
OP
|
$3,548.00
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
3302881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$3,370.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$59.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,128.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$59.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$2,128.80
|
| Rate for Payer: Cash Price |
$2,128.80
|
| Rate for Payer: Cigna Commercial |
$3,015.80
|
| Rate for Payer: First Health Commercial |
$3,193.20
|
| Rate for Payer: First Health Workers Compensation |
$1,369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,193.20
|
| Rate for Payer: GEHA Commercial |
$53.86
|
| Rate for Payer: GEHA Medicare |
$48.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,193.20
|
| Rate for Payer: Humana ChoiceCare |
$53.86
|
| Rate for Payer: Humana Medicare Advantage |
$48.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$82.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$48.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$48.96
|
| Rate for Payer: Multiplan All |
$3,228.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$83.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,483.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,193.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$55.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$48.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$48.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,370.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$97.92
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$47.98
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,299.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$48.96
|
| Rate for Payer: Zelis Auto |
$1,419.20
|
| Rate for Payer: Zelis Medicare |
$41.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.75
|
| Rate for Payer: Zelis Worker's Compensation |
$968.60
|
|
|
GAMUNEX-C 10% 20 GM/200 ML IV SOLN
|
Facility
|
IP
|
$6,334.00
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
3302882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,729.18 |
| Max. Negotiated Rate |
$6,017.30 |
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cigna Commercial |
$5,383.90
|
| Rate for Payer: First Health Commercial |
$5,700.60
|
| Rate for Payer: First Health Workers Compensation |
$2,445.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,700.60
|
| Rate for Payer: GEHA Commercial |
$4,433.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,700.60
|
| Rate for Payer: Multiplan All |
$5,763.94
|
| Rate for Payer: OMNI Networks Commercial |
$4,433.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,700.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,017.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,750.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,890.62
|
| Rate for Payer: Zelis Auto |
$2,533.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,729.18
|
|
|
GAMUNEX-C 10% 20 GM/200 ML IV SOLN
|
Facility
|
OP
|
$6,334.00
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
3302882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$6,017.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$59.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,800.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$59.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cigna Commercial |
$5,383.90
|
| Rate for Payer: First Health Commercial |
$5,700.60
|
| Rate for Payer: First Health Workers Compensation |
$2,445.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,700.60
|
| Rate for Payer: GEHA Commercial |
$53.86
|
| Rate for Payer: GEHA Medicare |
$48.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,700.60
|
| Rate for Payer: Humana ChoiceCare |
$53.86
|
| Rate for Payer: Humana Medicare Advantage |
$48.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$82.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$48.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$48.96
|
| Rate for Payer: Multiplan All |
$5,763.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$83.23
|
| Rate for Payer: OMNI Networks Commercial |
$4,433.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,700.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$55.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$48.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$48.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,017.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$97.92
|
| Rate for Payer: Three Rivers Provider Network All |
$4,750.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$47.98
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,890.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$48.96
|
| Rate for Payer: Zelis Auto |
$2,533.60
|
| Rate for Payer: Zelis Medicare |
$41.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.75
|
| Rate for Payer: Zelis Worker's Compensation |
$1,729.18
|
|
|
GAMUNEX- C 10% 5 GM/50 ML IV SOLN
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
3303027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$59.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,392.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$59.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cigna Commercial |
$1,972.00
|
| Rate for Payer: First Health Commercial |
$2,088.00
|
| Rate for Payer: First Health Workers Compensation |
$895.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,088.00
|
| Rate for Payer: GEHA Commercial |
$53.86
|
| Rate for Payer: GEHA Medicare |
$48.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,088.00
|
| Rate for Payer: Humana ChoiceCare |
$53.86
|
| Rate for Payer: Humana Medicare Advantage |
$48.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$82.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$48.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$48.96
|
| Rate for Payer: Multiplan All |
$2,111.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$83.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,624.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,088.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$55.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$48.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$48.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,204.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$97.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,740.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$47.98
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,157.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$48.96
|
| Rate for Payer: Zelis Auto |
$928.00
|
| Rate for Payer: Zelis Medicare |
$41.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.75
|
| Rate for Payer: Zelis Worker's Compensation |
$633.36
|
|
|
GAMUNEX- C 10% 5 GM/50 ML IV SOLN
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
3303027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$633.36 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cigna Commercial |
$1,972.00
|
| Rate for Payer: First Health Commercial |
$2,088.00
|
| Rate for Payer: First Health Workers Compensation |
$895.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,088.00
|
| Rate for Payer: GEHA Commercial |
$1,624.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,088.00
|
| Rate for Payer: Multiplan All |
$2,111.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,624.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,088.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,204.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,740.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,157.60
|
| Rate for Payer: Zelis Auto |
$928.00
|
| Rate for Payer: Zelis Worker's Compensation |
$633.36
|
|
|
GANGLIOSIDE GM1 AB IGG REF
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2300004
|
|
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
|
|
|
GANGLIOSIDE GM1 AB IGG REF
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2300004
|
|
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
|
|
|
GANGLIOSIDE GM1 AB IGM REF
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2300005
|
|
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
|
|
