|
ALCOHOL/SUBS INTERV 15-30MN
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT G0396
|
| Hospital Charge Code |
9199501
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| 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 |
$49.03
|
| 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 |
$34.67
|
|
|
ALCOHOL/SUBS INTERV 15-30MN
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT G0396
|
| Hospital Charge Code |
9199501
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| 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 |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$56.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$49.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
ALCOHOL/SUBS INTERV 15-30MN
|
Facility
|
OP
|
$29.42
|
|
|
Service Code
|
CPT G0396
|
| Hospital Charge Code |
810396
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna Commercial |
$25.01
|
| Rate for Payer: First Health Commercial |
$26.48
|
| Rate for Payer: First Health Workers Compensation |
$11.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.48
|
| Rate for Payer: GEHA Commercial |
$23.54
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.48
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$26.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$20.59
|
| Rate for Payer: One Health Plan PPO/POS |
$26.48
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$56.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$49.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$22.07
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$11.77
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$8.03
|
|
|
ALCOHOL/SUBS INTERV >30 MIN
|
Facility
|
IP
|
$57.69
|
|
|
Service Code
|
CPT G0397
|
| Hospital Charge Code |
810397
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Cash Price |
$34.61
|
| Rate for Payer: Cigna Commercial |
$49.04
|
| Rate for Payer: First Health Commercial |
$51.92
|
| Rate for Payer: First Health Workers Compensation |
$22.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.92
|
| Rate for Payer: GEHA Commercial |
$40.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.92
|
| Rate for Payer: Multiplan All |
$52.50
|
| Rate for Payer: OMNI Networks Commercial |
$40.38
|
| Rate for Payer: One Health Plan PPO/POS |
$51.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.81
|
| Rate for Payer: Three Rivers Provider Network All |
$43.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.65
|
| Rate for Payer: Zelis Auto |
$23.08
|
| Rate for Payer: Zelis Worker's Compensation |
$15.75
|
|
|
ALCOHOL/SUBS INTERV >30 MIN
|
Facility
|
OP
|
$57.69
|
|
|
Service Code
|
CPT G0397
|
| Hospital Charge Code |
810397
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$34.61
|
| Rate for Payer: Cash Price |
$34.61
|
| Rate for Payer: Cigna Commercial |
$49.04
|
| Rate for Payer: First Health Commercial |
$51.92
|
| Rate for Payer: First Health Workers Compensation |
$22.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.92
|
| Rate for Payer: GEHA Commercial |
$46.15
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.92
|
| 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 Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$52.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$40.38
|
| Rate for Payer: One Health Plan PPO/POS |
$51.92
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$56.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$49.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.81
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$43.27
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$23.08
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$15.75
|
|
|
ALCOHOL/SUBSTANCE SCRN & INTRVN 15-30 MI
|
Facility
|
IP
|
$33.41
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
8199408
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$31.74 |
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: First Health Commercial |
$30.07
|
| Rate for Payer: First Health Workers Compensation |
$12.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.07
|
| Rate for Payer: GEHA Commercial |
$23.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.07
|
| Rate for Payer: Multiplan All |
$30.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.39
|
| Rate for Payer: One Health Plan PPO/POS |
$30.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.74
|
| Rate for Payer: Three Rivers Provider Network All |
$25.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.07
|
| Rate for Payer: Zelis Auto |
$13.36
|
| Rate for Payer: Zelis Worker's Compensation |
$9.12
|
|
|
ALCOHOL/SUBSTANCE SCRN & INTRVN 15-30 MI
|
Facility
|
OP
|
$33.41
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
8199408
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$31.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.05
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: First Health Commercial |
$30.07
|
| Rate for Payer: First Health Workers Compensation |
$12.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.07
|
| Rate for Payer: GEHA Commercial |
$26.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.07
|
| Rate for Payer: Humana ChoiceCare |
$8.69
|
| Rate for Payer: Multiplan All |
$30.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.05
|
| Rate for Payer: OMNI Networks Commercial |
$23.39
|
| Rate for Payer: One Health Plan PPO/POS |
$30.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.74
|
| Rate for Payer: Three Rivers Provider Network All |
$25.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.07
|
| Rate for Payer: Zelis Auto |
$13.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.70
|
| Rate for Payer: Zelis Worker's Compensation |
$9.12
|
|
|
ALCOHOL/SUBSTANCE SCRN & INTRVN >30 MI
|
Facility
|
OP
|
$65.51
|
|
|
Service Code
|
CPT 99409
|
| Hospital Charge Code |
8199409
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cigna Commercial |
$55.68
|
| Rate for Payer: First Health Commercial |
$58.96
|
| Rate for Payer: First Health Workers Compensation |
$25.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.96
|
| Rate for Payer: GEHA Commercial |
$52.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.96
|
| Rate for Payer: Humana ChoiceCare |
$17.03
|
| Rate for Payer: Multiplan All |
$59.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.31
|
| Rate for Payer: OMNI Networks Commercial |
$45.86
|
| Rate for Payer: One Health Plan PPO/POS |
$58.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.23
|
| Rate for Payer: Three Rivers Provider Network All |
$49.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$57.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.92
|
| Rate for Payer: Zelis Auto |
$26.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.76
|
| Rate for Payer: Zelis Worker's Compensation |
$17.88
|
|
|
ALCOHOL/SUBSTANCE SCRN & INTRVN >30 MI
|
Facility
|
IP
|
$65.51
|
|
|
Service Code
|
CPT 99409
|
| Hospital Charge Code |
8199409
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cigna Commercial |
$55.68
|
| Rate for Payer: First Health Commercial |
$58.96
|
| Rate for Payer: First Health Workers Compensation |
$25.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.96
|
| Rate for Payer: GEHA Commercial |
$45.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.96
|
| Rate for Payer: Multiplan All |
$59.61
|
| Rate for Payer: OMNI Networks Commercial |
$45.86
|
| Rate for Payer: One Health Plan PPO/POS |
$58.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.23
|
| Rate for Payer: Three Rivers Provider Network All |
$49.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.92
|
| Rate for Payer: Zelis Auto |
$26.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.88
|
|
|
ALCOHOL/SUBSTNCE SCRN & INTRVN 15-30 MIN
|
Facility
|
OP
|
$33.41
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
8599408
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$31.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.05
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: First Health Commercial |
$30.07
|
| Rate for Payer: First Health Workers Compensation |
$12.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.07
|
| Rate for Payer: GEHA Commercial |
$26.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.07
|
| Rate for Payer: Humana ChoiceCare |
$8.69
|
| Rate for Payer: Multiplan All |
$30.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.05
|
| Rate for Payer: OMNI Networks Commercial |
$23.39
|
| Rate for Payer: One Health Plan PPO/POS |
$30.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.74
|
| Rate for Payer: Three Rivers Provider Network All |
$25.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.07
|
| Rate for Payer: Zelis Auto |
$13.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.70
|
| Rate for Payer: Zelis Worker's Compensation |
$9.12
|
|
|
ALCOHOL/SUBSTNCE SCRN & INTRVN 15-30 MIN
|
Facility
|
IP
|
$33.41
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
8599408
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$31.74 |
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: First Health Commercial |
$30.07
|
| Rate for Payer: First Health Workers Compensation |
$12.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.07
|
| Rate for Payer: GEHA Commercial |
$23.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.07
|
| Rate for Payer: Multiplan All |
$30.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.39
|
| Rate for Payer: One Health Plan PPO/POS |
$30.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.74
|
| Rate for Payer: Three Rivers Provider Network All |
$25.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.07
|
| Rate for Payer: Zelis Auto |
$13.36
|
| Rate for Payer: Zelis Worker's Compensation |
$9.12
|
|
|
ALCOHOL (Vitros)
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
2232221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$212.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Humana ChoiceCare |
$68.90
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$159.00
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$233.20
|
| Rate for Payer: United Healthcare Commercial |
$225.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
ALCOHOL (Vitros)
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
2232221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$185.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
alder, grey IgE REF602545
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299159
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
alder, grey IgE REF602545
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299159
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
aldolase REF002030
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
22990771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$17.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.72
|
|
|
aldolase REF002030
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
22990771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$17.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: GEHA Medicare |
$9.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Humana ChoiceCare |
$10.68
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.71
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.51
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.42
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$492.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.71
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Medicare |
$8.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.65
|
| Rate for Payer: Zelis Worker's Compensation |
$12.72
|
|
|
aldosterone 24 hour urine
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
2200699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$58.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$71.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$40.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$44.83
|
| Rate for Payer: Humana Medicare Advantage |
$40.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$68.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$59.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$40.75
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$69.28
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$68.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$59.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$40.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$81.50
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.94
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$40.75
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$34.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$48.90
|
| Rate for Payer: Zelis Worker's Compensation |
$50.54
|
|
|
aldosterone 24 hour urine
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
2200699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.54 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$71.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$50.54
|
|
|
aldosterone REF004374
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
22990758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$58.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$71.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$40.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$44.83
|
| Rate for Payer: Humana Medicare Advantage |
$40.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$68.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$59.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$40.75
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$69.28
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$68.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$59.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$40.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$81.50
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.94
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$40.75
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$34.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$48.90
|
| Rate for Payer: Zelis Worker's Compensation |
$50.54
|
|
|
aldosterone REF004374
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
22990758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.54 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$71.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$50.54
|
|
|
ALENDRONATE SODIUM 70MG WEEKLY TAB
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
NDC 69097022416
|
| Hospital Charge Code |
3300029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$100.30
|
| Rate for Payer: First Health Commercial |
$106.20
|
| Rate for Payer: First Health Workers Compensation |
$45.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$106.20
|
| Rate for Payer: GEHA Commercial |
$94.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$106.20
|
| Rate for Payer: Humana ChoiceCare |
$30.68
|
| Rate for Payer: Multiplan All |
$107.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.80
|
| Rate for Payer: OMNI Networks Commercial |
$82.60
|
| Rate for Payer: One Health Plan PPO/POS |
$106.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$112.10
|
| Rate for Payer: Three Rivers Provider Network All |
$88.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$103.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$109.74
|
| Rate for Payer: Zelis Auto |
$47.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$59.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.21
|
|
|
ALENDRONATE SODIUM 70MG WEEKLY TAB
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
NDC 69097022416
|
| Hospital Charge Code |
3300029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.21 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$100.30
|
| Rate for Payer: First Health Commercial |
$106.20
|
| Rate for Payer: First Health Workers Compensation |
$45.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$106.20
|
| Rate for Payer: GEHA Commercial |
$82.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$106.20
|
| Rate for Payer: Multiplan All |
$107.38
|
| Rate for Payer: OMNI Networks Commercial |
$82.60
|
| Rate for Payer: One Health Plan PPO/POS |
$106.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$112.10
|
| Rate for Payer: Three Rivers Provider Network All |
$88.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$109.74
|
| Rate for Payer: Zelis Auto |
$47.20
|
| Rate for Payer: Zelis Worker's Compensation |
$32.21
|
|
|
ALFUZOSIN HCL 10MG 24HR SR TAB
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
NDC 00024420010
|
| Hospital Charge Code |
3300030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: First Health Commercial |
$82.80
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.80
|
| Rate for Payer: GEHA Commercial |
$64.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.80
|
| Rate for Payer: Multiplan All |
$83.72
|
| Rate for Payer: OMNI Networks Commercial |
$64.40
|
| Rate for Payer: One Health Plan PPO/POS |
$82.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.40
|
| Rate for Payer: Three Rivers Provider Network All |
$69.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.56
|
| Rate for Payer: Zelis Auto |
$36.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
ALFUZOSIN HCL 10MG 24HR SR TAB
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
NDC 00024420010
|
| Hospital Charge Code |
3300030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: First Health Commercial |
$82.80
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.80
|
| Rate for Payer: GEHA Commercial |
$73.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.80
|
| Rate for Payer: Humana ChoiceCare |
$23.92
|
| Rate for Payer: Multiplan All |
$83.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.20
|
| Rate for Payer: OMNI Networks Commercial |
$64.40
|
| Rate for Payer: One Health Plan PPO/POS |
$82.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.40
|
| Rate for Payer: Three Rivers Provider Network All |
$69.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.56
|
| Rate for Payer: Zelis Auto |
$36.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
