|
hsv culture and typing REF008250
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
2200210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$123.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$87.11
|
|
|
htlv-i/ii antibodies qual REF164277
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.19
|
| 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 |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.88
|
| 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 |
$19.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$12.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$14.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.88
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.90
|
| 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 |
$21.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.76
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.62
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.88
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$10.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.46
|
| Rate for Payer: Zelis Worker's Compensation |
$14.04
|
|
|
htlv-i/ii antibodies qual REF164277
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2200214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| 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 |
$19.86
|
| 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 |
$14.04
|
|
|
human epididymis protein4 REF081700
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
2200739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$27.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$297.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$19.70
|
|
|
human epididymis protein4 REF081700
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
2200739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$27.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.70
|
|
|
HUMERA 1M INJ - PT OWN MED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J0135
|
| Hospital Charge Code |
8500135
|
|
Hospital Revenue Code
|
521
|
| Max. Negotiated Rate |
$988.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$988.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$988.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$782.75
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$798.69
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$922.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$798.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$798.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
HUMERA 1M INJ - PT OWN MED
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J0135
|
| Hospital Charge Code |
8500135
|
|
Hospital Revenue Code
|
521
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
HUMERAL HEAD
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7004282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,400.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$4,725.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
|
|
HUMERAL HEAD
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7004282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$5,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Humana ChoiceCare |
$1,755.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,050.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,940.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,375.00
|
|
|
HUMERAL HEAD 49/20
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,400.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$4,725.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
|
|
HUMERAL HEAD 49/20
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$5,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Humana ChoiceCare |
$1,755.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,050.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,940.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,375.00
|
|
|
HUMERAL HEAD ECLIPSE 43/18
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$5,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Humana ChoiceCare |
$1,755.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,050.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,940.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,375.00
|
|
|
HUMERAL HEAD ECLIPSE 43/18
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,400.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$4,725.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
|
|
HUMERAL HEAD ECLIPSE 47/20
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$5,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Humana ChoiceCare |
$1,755.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,050.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,940.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,375.00
|
|
|
HUMERAL HEAD ECLIPSE 47/20
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,400.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cash Price |
$4,050.00
|
| Rate for Payer: Cigna Commercial |
$5,737.50
|
| Rate for Payer: First Health Commercial |
$6,075.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,075.00
|
| Rate for Payer: GEHA Commercial |
$4,725.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,075.00
|
| Rate for Payer: Multiplan All |
$6,142.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,725.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,075.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,412.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,062.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,277.50
|
| Rate for Payer: Zelis Auto |
$2,700.00
|
|
|
HUMIDIFIER HEATED USED W PAP
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT E0562
|
| Hospital Charge Code |
3000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
HUMIDIFIER HEATED USED W PAP
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT E0562
|
| Hospital Charge Code |
3000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$105.04
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$242.40
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$355.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
HUMIDIFIER NONHEATED W PAP
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT E0561
|
| Hospital Charge Code |
3000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
HUMIDIFIER NONHEATED W PAP
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT E0561
|
| Hospital Charge Code |
3000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$105.04
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$242.40
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$355.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
huntington disease genetic REF620016
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 81271
|
| Hospital Charge Code |
2200808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$162.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$566.10
|
| Rate for Payer: First Health Commercial |
$599.40
|
| Rate for Payer: First Health Workers Compensation |
$156.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$599.40
|
| Rate for Payer: GEHA Commercial |
$532.80
|
| Rate for Payer: GEHA Medicare |
$137.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$599.40
|
| Rate for Payer: Humana ChoiceCare |
$150.70
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$230.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$166.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$137.00
|
| Rate for Payer: Multiplan All |
$606.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$232.90
|
| Rate for Payer: OMNI Networks Commercial |
$466.20
|
| Rate for Payer: One Health Plan PPO/POS |
$599.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$191.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$166.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$137.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$632.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$274.00
|
| Rate for Payer: Three Rivers Provider Network All |
$499.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$134.26
|
| Rate for Payer: United Healthcare Commercial |
$566.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$619.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$137.00
|
| Rate for Payer: Zelis Auto |
$266.40
|
| Rate for Payer: Zelis Medicare |
$116.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.89
|
|
|
huntington disease genetic REF620016
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 81271
|
| Hospital Charge Code |
2200808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$566.10
|
| Rate for Payer: First Health Commercial |
$599.40
|
| Rate for Payer: First Health Workers Compensation |
$156.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$599.40
|
| Rate for Payer: GEHA Commercial |
$466.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$599.40
|
| Rate for Payer: Multiplan All |
$606.06
|
| Rate for Payer: OMNI Networks Commercial |
$466.20
|
| Rate for Payer: One Health Plan PPO/POS |
$599.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$632.70
|
| Rate for Payer: Three Rivers Provider Network All |
$499.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$619.38
|
| Rate for Payer: Zelis Auto |
$266.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.89
|
|
|
hydrALAZINE HCL INJ 20MG/ML
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT J0360
|
| Hospital Charge Code |
3300407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$15.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
hydrALAZINE HCL INJ 20MG/ML
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT J0360
|
| Hospital Charge Code |
3300407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$6.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Humana ChoiceCare |
$5.72
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.20
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
hydrALAZINE HCL TAB 25MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3300409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
hydrALAZINE HCL TAB 25MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3300409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
