|
GROWTH HORMONE
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2300125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
growth hormone REF004275
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
22000205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
growth hormone REF004275
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
22000205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
|
GRP ADAPT BHV PRTCL MODIFAJ PHYS/QHP EA
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 97158
|
| Hospital Charge Code |
4397927
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$15.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$10.74
|
|
|
GRP ADAPT BHV PRTCL MODIFAJ PHYS/QHP EA
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 97158
|
| Hospital Charge Code |
4397927
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
GTT 1 HOUR
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 1 HOUR
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$12.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$14.16
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.87
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.88
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.74
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.61
|
| Rate for Payer: United Healthcare Commercial |
$181.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.87
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$10.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.44
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 2 HOUR
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 2 HOUR
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$12.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$14.16
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.87
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.88
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.74
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.61
|
| Rate for Payer: United Healthcare Commercial |
$181.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.87
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$10.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.44
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 3 HOUR
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$12.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$14.16
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.87
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.88
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.74
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.61
|
| Rate for Payer: United Healthcare Commercial |
$181.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.87
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$10.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.44
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 3 HOUR
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 4 HOUR
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$12.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$14.16
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.87
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.88
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.74
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.61
|
| Rate for Payer: United Healthcare Commercial |
$181.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.87
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$10.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.44
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT 4 HOUR
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
2290015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$20.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.83
|
|
|
GTT FASTING GLUCOSE (Vitros)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2290020
|
|
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
|
|
|
GTT FASTING GLUCOSE (Vitros)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2290020
|
|
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
|
|
|
guaiFENesin-COD 100-10MG/5ML FOR AGE 18+
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00121177505
|
| Hospital Charge Code |
3300393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
guaiFENesin-COD 100-10MG/5ML FOR AGE 18+
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00121177505
|
| Hospital Charge Code |
3300393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
guaiFENesin DM SYRUP 200-20MG/10ML
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 00121063805
|
| Hospital Charge Code |
3300226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
guaiFENesin DM SYRUP 200-20MG/10ML
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 00121063805
|
| Hospital Charge Code |
3300226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
guaiFENesin LIQUID 100MG/5ML
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3300391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
guaiFENesin LIQUID 100MG/5ML
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00121174405
|
| Hospital Charge Code |
3300391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
guaiFENesin TAB SR 12HR 600MG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 63824000815
|
| Hospital Charge Code |
3300392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
guaiFENesin TAB SR 12HR 600MG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 63824000815
|
| Hospital Charge Code |
3300392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
GUIDEWIRE 2.0 0.8X100
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$1,082.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Humana ChoiceCare |
$351.78
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$811.80
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,190.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$676.50
|
|
|
GUIDEWIRE 2.0 0.8X100
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,082.40
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$947.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
|
