|
imipramine REF007468
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
2200106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
IMLPT HEMOSTAT PRE-LOADED ENDOAVITENE
|
Facility
|
IP
|
$3,019.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7001699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.60 |
| Max. Negotiated Rate |
$2,868.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,415.20
|
| Rate for Payer: Cash Price |
$1,811.40
|
| Rate for Payer: Cash Price |
$1,811.40
|
| Rate for Payer: Cigna Commercial |
$2,566.15
|
| Rate for Payer: First Health Commercial |
$2,717.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,717.10
|
| Rate for Payer: GEHA Commercial |
$2,113.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,717.10
|
| Rate for Payer: Multiplan All |
$2,747.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,113.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,717.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,868.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,264.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,807.67
|
| Rate for Payer: Zelis Auto |
$1,207.60
|
|
|
IMLPT HEMOSTAT PRE-LOADED ENDOAVITENE
|
Facility
|
OP
|
$3,019.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7001699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.75 |
| Max. Negotiated Rate |
$2,868.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,811.40
|
| Rate for Payer: Cash Price |
$1,811.40
|
| Rate for Payer: Cash Price |
$1,811.40
|
| Rate for Payer: Cigna Commercial |
$2,566.15
|
| Rate for Payer: First Health Commercial |
$2,717.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,717.10
|
| Rate for Payer: GEHA Commercial |
$2,415.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,717.10
|
| Rate for Payer: Humana ChoiceCare |
$784.94
|
| Rate for Payer: Multiplan All |
$2,747.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,811.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,113.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,717.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,868.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,264.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,656.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$754.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,807.67
|
| Rate for Payer: Zelis Auto |
$1,207.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,509.50
|
|
|
IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
8590481
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
9390480
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
8590481
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$78.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$70.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$70.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$39.42
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$32.00
|
| Rate for Payer: GEHA Medicare |
$39.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Humana ChoiceCare |
$43.36
|
| Rate for Payer: Humana Medicare Advantage |
$39.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$66.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$56.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$39.42
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.01
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$65.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$56.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$39.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$78.84
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$39.42
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Medicare |
$33.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.30
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
9390480
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$78.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$70.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$70.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$39.42
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$32.00
|
| Rate for Payer: GEHA Medicare |
$39.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Humana ChoiceCare |
$43.36
|
| Rate for Payer: Humana Medicare Advantage |
$39.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$66.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$56.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$39.42
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.01
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$65.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$56.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$39.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$78.84
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$39.42
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Medicare |
$33.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.30
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
IMMEDIATE CYTOLOGICAL EVALUATION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
2299070
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$64.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$45.75
|
|
|
IMMEDIATE CYTOLOGICAL EVALUATION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
2299070
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$64.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.75
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$71.17
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
8590473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$67.61 |
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cigna Commercial |
$60.49
|
| Rate for Payer: First Health Commercial |
$64.05
|
| Rate for Payer: First Health Workers Compensation |
$27.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.05
|
| Rate for Payer: GEHA Commercial |
$49.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.05
|
| Rate for Payer: Multiplan All |
$64.76
|
| Rate for Payer: OMNI Networks Commercial |
$49.82
|
| Rate for Payer: One Health Plan PPO/POS |
$64.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.61
|
| Rate for Payer: Three Rivers Provider Network All |
$53.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.19
|
| Rate for Payer: Zelis Auto |
$28.47
|
| Rate for Payer: Zelis Worker's Compensation |
$19.43
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
21600333
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: First Health Workers Compensation |
$26.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$55.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$18.84
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
9390473
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$53.60
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$71.17
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7290473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cigna Commercial |
$60.49
|
| Rate for Payer: First Health Commercial |
$64.05
|
| Rate for Payer: First Health Workers Compensation |
$27.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.05
|
| Rate for Payer: GEHA Commercial |
$56.94
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.05
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$64.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$49.82
|
| Rate for Payer: One Health Plan PPO/POS |
$64.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.61
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$53.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$28.47
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$19.43
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$71.17
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7290473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$67.61 |
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cigna Commercial |
$60.49
|
| Rate for Payer: First Health Commercial |
$64.05
|
| Rate for Payer: First Health Workers Compensation |
$27.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.05
|
| Rate for Payer: GEHA Commercial |
$49.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.05
|
| Rate for Payer: Multiplan All |
$64.76
|
| Rate for Payer: OMNI Networks Commercial |
$49.82
|
| Rate for Payer: One Health Plan PPO/POS |
$64.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.61
|
| Rate for Payer: Three Rivers Provider Network All |
$53.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.19
|
| Rate for Payer: Zelis Auto |
$28.47
|
| Rate for Payer: Zelis Worker's Compensation |
$19.43
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$71.17
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
8590473
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cigna Commercial |
$60.49
|
| Rate for Payer: First Health Commercial |
$64.05
|
| Rate for Payer: First Health Workers Compensation |
$27.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.05
|
| Rate for Payer: GEHA Commercial |
$56.94
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.05
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$64.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$49.82
|
| Rate for Payer: One Health Plan PPO/POS |
$64.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.61
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$53.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$28.47
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$19.43
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
21600333
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: First Health Workers Compensation |
$26.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$48.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Worker's Compensation |
$18.84
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
9390473
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$46.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
IMMUNE ADMIN ORAL/NASAL A
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
21600334
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
IMMUNE ADMIN ORAL/NASAL A
|
Facility
|
OP
|
$33.33
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
8590474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: First Health Commercial |
$30.00
|
| Rate for Payer: First Health Workers Compensation |
$12.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.00
|
| Rate for Payer: GEHA Commercial |
$26.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.00
|
| Rate for Payer: Humana ChoiceCare |
$8.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$30.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.00
|
| Rate for Payer: OMNI Networks Commercial |
$23.33
|
| Rate for Payer: One Health Plan PPO/POS |
$30.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.66
|
| Rate for Payer: Three Rivers Provider Network All |
$25.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.00
|
| Rate for Payer: Zelis Auto |
$13.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.66
|
| Rate for Payer: Zelis Worker's Compensation |
$9.10
|
|
|
IMMUNE ADMIN ORAL/NASAL A
|
Facility
|
IP
|
$33.33
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
8590474
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$31.66 |
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: First Health Commercial |
$30.00
|
| Rate for Payer: First Health Workers Compensation |
$12.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.00
|
| Rate for Payer: GEHA Commercial |
$23.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.00
|
| Rate for Payer: Multiplan All |
$30.33
|
| Rate for Payer: OMNI Networks Commercial |
$23.33
|
| Rate for Payer: One Health Plan PPO/POS |
$30.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.66
|
| Rate for Payer: Three Rivers Provider Network All |
$25.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.00
|
| Rate for Payer: Zelis Auto |
$13.33
|
| Rate for Payer: Zelis Worker's Compensation |
$9.10
|
|
|
IMMUNE ADMIN ORAL/NASAL A
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
21600334
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.60
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
IMMUNE ADMIN ORAL/NASAL EACH ADDL
|
Facility
|
OP
|
$33.87
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
9390474
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cigna Commercial |
$28.79
|
| Rate for Payer: First Health Commercial |
$30.48
|
| Rate for Payer: First Health Workers Compensation |
$13.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.48
|
| Rate for Payer: GEHA Commercial |
$27.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.48
|
| Rate for Payer: Humana ChoiceCare |
$8.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$30.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.32
|
| Rate for Payer: OMNI Networks Commercial |
$23.71
|
| Rate for Payer: One Health Plan PPO/POS |
$30.48
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.18
|
| Rate for Payer: Three Rivers Provider Network All |
$25.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.50
|
| Rate for Payer: Zelis Auto |
$13.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.93
|
| Rate for Payer: Zelis Worker's Compensation |
$9.25
|
|
|
IMMUNE ADMIN ORAL/NASAL EACH ADDL
|
Facility
|
IP
|
$33.87
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
9390474
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cigna Commercial |
$28.79
|
| Rate for Payer: First Health Commercial |
$30.48
|
| Rate for Payer: First Health Workers Compensation |
$13.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.48
|
| Rate for Payer: GEHA Commercial |
$23.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.48
|
| Rate for Payer: Multiplan All |
$30.82
|
| Rate for Payer: OMNI Networks Commercial |
$23.71
|
| Rate for Payer: One Health Plan PPO/POS |
$30.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.18
|
| Rate for Payer: Three Rivers Provider Network All |
$25.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.50
|
| Rate for Payer: Zelis Auto |
$13.55
|
| Rate for Payer: Zelis Worker's Compensation |
$9.25
|
|
|
IMMUNIZATION ADMIN, ADD-ON; EA ADD'L VAC
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8190472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$16.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Humana ChoiceCare |
$5.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.00
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
|
IMMUNIZATION ADMIN, ADD-ON; EA ADD'L VAC
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8190472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$14.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
