|
GLIADIN ANTIBODY IGA
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200459
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
GLIMEPIRIDE 2 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084032601
|
| Hospital Charge Code |
3302983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| 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 |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
GLIMEPIRIDE 2 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084032601
|
| Hospital Charge Code |
3302983
|
|
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
|
|
|
GLIMEPIRIDE TAB 4 MG TAB
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 51079042601
|
| Hospital Charge Code |
3300382
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
GLIMEPIRIDE TAB 4 MG TAB
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 51079042601
|
| Hospital Charge Code |
3300382
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
GlipiZIDE TAB 5MG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00781145201
|
| Hospital Charge Code |
3300383
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
GlipiZIDE TAB 5MG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 00781145201
|
| Hospital Charge Code |
3300383
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
GLUCAGON HCL INJ 1MG
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
3300385
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$294.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$294.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$233.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$182.45
|
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cigna Commercial |
$406.30
|
| Rate for Payer: First Health Commercial |
$430.20
|
| Rate for Payer: First Health Workers Compensation |
$184.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$430.20
|
| Rate for Payer: GEHA Commercial |
$200.69
|
| Rate for Payer: GEHA Medicare |
$182.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$430.20
|
| Rate for Payer: Humana ChoiceCare |
$200.69
|
| Rate for Payer: Humana Medicare Advantage |
$182.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$306.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$238.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$182.45
|
| Rate for Payer: Multiplan All |
$434.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.17
|
| Rate for Payer: OMNI Networks Commercial |
$334.60
|
| Rate for Payer: One Health Plan PPO/POS |
$430.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$275.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$238.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$182.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$454.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$364.90
|
| Rate for Payer: Three Rivers Provider Network All |
$358.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$238.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$444.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$182.45
|
| Rate for Payer: Zelis Auto |
$191.20
|
| Rate for Payer: Zelis Medicare |
$155.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.94
|
| Rate for Payer: Zelis Worker's Compensation |
$130.49
|
|
|
GLUCAGON HCL INJ 1MG
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
3300385
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cigna Commercial |
$406.30
|
| Rate for Payer: First Health Commercial |
$430.20
|
| Rate for Payer: First Health Workers Compensation |
$184.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$430.20
|
| Rate for Payer: GEHA Commercial |
$334.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$430.20
|
| Rate for Payer: Multiplan All |
$434.98
|
| Rate for Payer: OMNI Networks Commercial |
$334.60
|
| Rate for Payer: One Health Plan PPO/POS |
$430.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$454.10
|
| Rate for Payer: Three Rivers Provider Network All |
$358.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$444.54
|
| Rate for Payer: Zelis Auto |
$191.20
|
| Rate for Payer: Zelis Worker's Compensation |
$130.49
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
21600039
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
20300045
|
|
Hospital Revenue Code
|
510
|
| 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 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
21582962
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
21582962
|
|
Hospital Revenue Code
|
510
|
| 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 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
25500039
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
25500039
|
|
Hospital Revenue Code
|
510
|
| 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 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
20300045
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
GLUC BLD GLUC MNTR DEV CLRD FDA SPEC HOM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
21600039
|
|
Hospital Revenue Code
|
517
|
| 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 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
|
|
|
GLUCOSE 2 Hour (Vitros)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2233402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$4.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.93
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
GLUCOSE 2 Hour (Vitros)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2233402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
glucose body fluid REF019497
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
22990907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$7.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$4.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.93
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$4.98
|
|
|
glucose body fluid REF019497
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
22990907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$7.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.98
|
|
|
GLUCOSE GEL 15 GM
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 56151162501
|
| Hospital Charge Code |
3302933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$15.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
GLUCOSE GEL 15 GM
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 56151162501
|
| Hospital Charge Code |
3302933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
Glucose POC (Glucose Finger Stick)
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
2299340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: First Health Commercial |
$43.20
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$43.20
|
| Rate for Payer: GEHA Commercial |
$38.40
|
| Rate for Payer: GEHA Medicare |
$5.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$43.20
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.04
|
| Rate for Payer: Multiplan All |
$43.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.57
|
| Rate for Payer: OMNI Networks Commercial |
$33.60
|
| Rate for Payer: One Health Plan PPO/POS |
$43.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.08
|
| Rate for Payer: Three Rivers Provider Network All |
$36.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.94
|
| Rate for Payer: United Healthcare Commercial |
$40.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.04
|
| Rate for Payer: Zelis Auto |
$19.20
|
| Rate for Payer: Zelis Medicare |
$4.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.05
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
Glucose POC (Glucose Finger Stick)
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
2299340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: First Health Commercial |
$43.20
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$43.20
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$43.20
|
| Rate for Payer: Multiplan All |
$43.68
|
| Rate for Payer: OMNI Networks Commercial |
$33.60
|
| Rate for Payer: One Health Plan PPO/POS |
$43.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.60
|
| Rate for Payer: Three Rivers Provider Network All |
$36.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.64
|
| Rate for Payer: Zelis Auto |
$19.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
