|
activated protein c resistance REF117762
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
2200517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
activated protein c resistance REF117762
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
2200517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: GEHA Medicare |
$15.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.32
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.04
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.64
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.01
|
| Rate for Payer: United Healthcare Commercial |
$192.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.32
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Medicare |
$13.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.38
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
ACTIVE WOUND CARE/20 CM O
|
Facility
|
IP
|
$271.62
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8597597
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.15 |
| Max. Negotiated Rate |
$258.04 |
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Cigna Commercial |
$230.88
|
| Rate for Payer: First Health Commercial |
$244.46
|
| Rate for Payer: First Health Workers Compensation |
$104.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.46
|
| Rate for Payer: GEHA Commercial |
$190.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.46
|
| Rate for Payer: Multiplan All |
$247.17
|
| Rate for Payer: OMNI Networks Commercial |
$190.13
|
| Rate for Payer: One Health Plan PPO/POS |
$244.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.04
|
| Rate for Payer: Three Rivers Provider Network All |
$203.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.61
|
| Rate for Payer: Zelis Auto |
$108.65
|
| Rate for Payer: Zelis Worker's Compensation |
$74.15
|
|
|
ACTIVE WOUND CARE/20 CM O
|
Facility
|
OP
|
$271.62
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8597597
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.15 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Cigna Commercial |
$230.88
|
| Rate for Payer: First Health Commercial |
$244.46
|
| Rate for Payer: First Health Workers Compensation |
$104.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.46
|
| Rate for Payer: GEHA Commercial |
$217.30
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.46
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$247.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$190.13
|
| Rate for Payer: One Health Plan PPO/POS |
$244.46
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$203.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$108.65
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$74.15
|
|
|
ACTIVE WOUND CARE/20 CM O
|
Facility
|
IP
|
$271.62
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7297597
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$74.15 |
| Max. Negotiated Rate |
$258.04 |
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Cigna Commercial |
$230.88
|
| Rate for Payer: First Health Commercial |
$244.46
|
| Rate for Payer: First Health Workers Compensation |
$104.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.46
|
| Rate for Payer: GEHA Commercial |
$190.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.46
|
| Rate for Payer: Multiplan All |
$247.17
|
| Rate for Payer: OMNI Networks Commercial |
$190.13
|
| Rate for Payer: One Health Plan PPO/POS |
$244.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.04
|
| Rate for Payer: Three Rivers Provider Network All |
$203.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.61
|
| Rate for Payer: Zelis Auto |
$108.65
|
| Rate for Payer: Zelis Worker's Compensation |
$74.15
|
|
|
ACTIVE WOUND CARE/20 CM O
|
Facility
|
OP
|
$271.62
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7297597
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$74.15 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Cigna Commercial |
$230.88
|
| Rate for Payer: First Health Commercial |
$244.46
|
| Rate for Payer: First Health Workers Compensation |
$104.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.46
|
| Rate for Payer: GEHA Commercial |
$217.30
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.46
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$247.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$190.13
|
| Rate for Payer: One Health Plan PPO/POS |
$244.46
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$203.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$108.65
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$74.15
|
|
|
ACYCLOVIR 200MG/5ML SUSPENSION
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
NDC 00472008216
|
| Hospital Charge Code |
3300020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$67.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$140.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Humana ChoiceCare |
$45.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.00
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$154.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$87.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.77
|
|
|
ACYCLOVIR 200MG/5ML SUSPENSION
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
NDC 00472008216
|
| Hospital Charge Code |
3300020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$67.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$122.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Worker's Compensation |
$47.77
|
|
|
ACYCLOVIR 200MG CAP
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 00904578961
|
| Hospital Charge Code |
3300017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
ACYCLOVIR 200MG CAP
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 00904578961
|
| Hospital Charge Code |
3300017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
ACYCLOVIR 5% OINTMENT
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
NDC 00378870006
|
| Hospital Charge Code |
3300018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: First Health Workers Compensation |
$224.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.90
|
| Rate for Payer: GEHA Commercial |
$406.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.90
|
| Rate for Payer: Multiplan All |
$528.71
|
| Rate for Payer: OMNI Networks Commercial |
$406.70
|
| Rate for Payer: One Health Plan PPO/POS |
$522.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.95
|
| Rate for Payer: Three Rivers Provider Network All |
$435.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$540.33
|
| Rate for Payer: Zelis Auto |
$232.40
|
| Rate for Payer: Zelis Worker's Compensation |
$158.61
|
|
|
ACYCLOVIR 5% OINTMENT
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
NDC 00378870006
|
| Hospital Charge Code |
3300018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.25 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: First Health Workers Compensation |
$224.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.90
|
| Rate for Payer: GEHA Commercial |
$464.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.90
|
| Rate for Payer: Humana ChoiceCare |
$151.06
|
| Rate for Payer: Multiplan All |
$528.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$348.60
|
| Rate for Payer: OMNI Networks Commercial |
$406.70
|
| Rate for Payer: One Health Plan PPO/POS |
$522.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.95
|
| Rate for Payer: Three Rivers Provider Network All |
$435.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$511.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$540.33
|
| Rate for Payer: Zelis Auto |
$232.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$290.50
|
| Rate for Payer: Zelis Worker's Compensation |
$158.61
|
|
|
ACYCLOVIR SODIUM 500MG FOR IVPB
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT J0133
|
| Hospital Charge Code |
3300019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$0.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
ACYCLOVIR SODIUM 500MG FOR IVPB
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT J0133
|
| Hospital Charge Code |
3300019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
acylcarnitine profile plasma REF 070228
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
2299316
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$202.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$287.30
|
| Rate for Payer: First Health Commercial |
$304.20
|
| Rate for Payer: First Health Workers Compensation |
$29.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$304.20
|
| Rate for Payer: GEHA Commercial |
$270.40
|
| Rate for Payer: GEHA Medicare |
$16.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$304.20
|
| Rate for Payer: Humana ChoiceCare |
$18.56
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.87
|
| Rate for Payer: Multiplan All |
$307.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.68
|
| Rate for Payer: OMNI Networks Commercial |
$236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$321.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.74
|
| Rate for Payer: Three Rivers Provider Network All |
$253.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$287.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$314.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.87
|
| Rate for Payer: Zelis Auto |
$135.20
|
| Rate for Payer: Zelis Medicare |
$14.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.24
|
| Rate for Payer: Zelis Worker's Compensation |
$20.92
|
|
|
acylcarnitine profile plasma REF 070228
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
2299316
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$287.30
|
| Rate for Payer: First Health Commercial |
$304.20
|
| Rate for Payer: First Health Workers Compensation |
$29.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$304.20
|
| Rate for Payer: GEHA Commercial |
$236.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$304.20
|
| Rate for Payer: Multiplan All |
$307.58
|
| Rate for Payer: OMNI Networks Commercial |
$236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$321.10
|
| Rate for Payer: Three Rivers Provider Network All |
$253.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$314.34
|
| Rate for Payer: Zelis Auto |
$135.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.92
|
|
|
acylglycines quant random ur REF 8310044
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
acylglycines quant random ur REF 8310044
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$24.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.09
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.18
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.09
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$20.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.91
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
adamts13 activity REF117913
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
2200727
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$34.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$254.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.65
|
|
|
adamts13 activity REF117913
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
2200727
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$34.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: GEHA Medicare |
$30.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Humana ChoiceCare |
$33.95
|
| Rate for Payer: Humana Medicare Advantage |
$30.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$51.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$44.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$30.86
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.46
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$51.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$44.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$30.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$61.72
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.24
|
| Rate for Payer: United Healthcare Commercial |
$309.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$30.86
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Medicare |
$26.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$37.03
|
| Rate for Payer: Zelis Worker's Compensation |
$24.65
|
|
|
adamts13 antibody REF117915
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
adamts13 antibody REF117915
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 97155
|
| Hospital Charge Code |
4397924
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$25.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$18.21
|
|
|
ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 97155
|
| Hospital Charge Code |
4397924
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 97153
|
| Hospital Charge Code |
4397922
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
