|
ACETYLCHOLINE 1% OPTHALMIC
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
3300015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
ACETYLCHOLINE RCPT BINDING AB REF
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2300010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
ACETYLCHOLINE RCPT BINDING AB REF
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2300010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
acetylcholine rcpt bindng ab REF085902
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2200061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
acetylcholine rcpt bindng ab REF085902
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2200061
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
ACETYLCHOLINE RCPT MODULATION AB REF
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2300011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
ACETYLCHOLINE RCPT MODULATION AB REF
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2300011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
acetylcholine rcpt modultng ab REF085933
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2200062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
acetylcholine rcpt modultng ab REF085933
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2200062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
acetylcholine rcptr block ab REF085926
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299360
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$20.24
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.40
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.28
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.40
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$15.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.08
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
acetylcholine rcptr block ab REF085926
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2299360
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$20.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.64
|
|
|
ACETYLCYSTEINE 200MG/ML FOR IV USE
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT J0132
|
| Hospital Charge Code |
3301114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$229.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1.18
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cigna Commercial |
$324.70
|
| Rate for Payer: First Health Commercial |
$343.80
|
| Rate for Payer: First Health Workers Compensation |
$147.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$343.80
|
| Rate for Payer: GEHA Commercial |
$0.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$343.80
|
| Rate for Payer: Humana ChoiceCare |
$99.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1.20
|
| Rate for Payer: Multiplan All |
$347.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$229.20
|
| Rate for Payer: OMNI Networks Commercial |
$267.40
|
| Rate for Payer: One Health Plan PPO/POS |
$343.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$362.90
|
| Rate for Payer: Three Rivers Provider Network All |
$286.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$336.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$355.26
|
| Rate for Payer: Zelis Auto |
$152.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$191.00
|
| Rate for Payer: Zelis Worker's Compensation |
$104.29
|
|
|
ACETYLCYSTEINE 200MG/ML FOR IV USE
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT J0132
|
| Hospital Charge Code |
3301114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.29 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cigna Commercial |
$324.70
|
| Rate for Payer: First Health Commercial |
$343.80
|
| Rate for Payer: First Health Workers Compensation |
$147.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$343.80
|
| Rate for Payer: GEHA Commercial |
$267.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$343.80
|
| Rate for Payer: Multiplan All |
$347.62
|
| Rate for Payer: OMNI Networks Commercial |
$267.40
|
| Rate for Payer: One Health Plan PPO/POS |
$343.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$362.90
|
| Rate for Payer: Three Rivers Provider Network All |
$286.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$355.26
|
| Rate for Payer: Zelis Auto |
$152.80
|
| Rate for Payer: Zelis Worker's Compensation |
$104.29
|
|
|
ACETYLCYSTEINE 20% 4 ML INHALATION sol
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 63323069404
|
| Hospital Charge Code |
3302931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$38.22
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$88.20
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$129.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.50
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
ACETYLCYSTEINE 20% 4 ML INHALATION sol
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 63323069404
|
| Hospital Charge Code |
3302931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
ACETYLCYSTEINE 20% INHALATION SOLUTION
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
NDC 00409330803
|
| Hospital Charge Code |
3300016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$36.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$75.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Humana ChoiceCare |
$24.44
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$56.40
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$82.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.66
|
|
|
ACETYLCYSTEINE 20% INHALATION SOLUTION
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
NDC 00409330803
|
| Hospital Charge Code |
3300016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$36.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$65.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Worker's Compensation |
$25.66
|
|
|
ACNE SURGERY
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
6110040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
ACNE SURGERY
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
8510040
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$186.19 |
| Max. Negotiated Rate |
$647.90 |
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$263.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$477.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Worker's Compensation |
$186.19
|
|
|
ACNE SURGERY
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
6110040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
ACNE SURGERY
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
8510040
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$647.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$409.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$263.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$545.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$186.19
|
|
|
acth plasma REF004440
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
2209997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$62.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
acth plasma REF004440
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
2209997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$69.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$69.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$55.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$62.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: GEHA Medicare |
$38.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$42.48
|
| Rate for Payer: Humana Medicare Advantage |
$38.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$64.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$56.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$38.62
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.65
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$64.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$56.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$38.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$77.24
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$37.85
|
| Rate for Payer: United Healthcare Commercial |
$184.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$38.62
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Medicare |
$32.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.34
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
actin smooth muscle ab IgG REF006643
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
22990781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$184.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
actin smooth muscle ab IgG REF006643
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
22990781
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
