|
INFLIXIMAB-DYYB 100 MG PWVL
|
Facility
|
OP
|
$2,384.00
|
|
|
Service Code
|
CPT Q5103
|
| Hospital Charge Code |
3302918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$2,264.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.99
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cigna Commercial |
$2,026.40
|
| Rate for Payer: First Health Commercial |
$2,145.60
|
| Rate for Payer: First Health Workers Compensation |
$920.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,145.60
|
| Rate for Payer: GEHA Commercial |
$21.99
|
| Rate for Payer: GEHA Medicare |
$19.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,145.60
|
| Rate for Payer: Humana ChoiceCare |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$19.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$33.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.99
|
| Rate for Payer: Multiplan All |
$2,169.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,668.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,145.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,264.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.98
|
| Rate for Payer: Three Rivers Provider Network All |
$1,788.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$596.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,217.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.99
|
| Rate for Payer: Zelis Auto |
$953.60
|
| Rate for Payer: Zelis Medicare |
$16.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.99
|
| Rate for Payer: Zelis Worker's Compensation |
$650.83
|
|
|
INFLIXIMAB-DYYB 100 MG PWVL
|
Facility
|
IP
|
$2,384.00
|
|
|
Service Code
|
CPT Q5103
|
| Hospital Charge Code |
3302918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$650.83 |
| Max. Negotiated Rate |
$2,264.80 |
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cigna Commercial |
$2,026.40
|
| Rate for Payer: First Health Commercial |
$2,145.60
|
| Rate for Payer: First Health Workers Compensation |
$920.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,145.60
|
| Rate for Payer: GEHA Commercial |
$1,668.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,145.60
|
| Rate for Payer: Multiplan All |
$2,169.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,668.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,145.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,264.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,788.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,217.12
|
| Rate for Payer: Zelis Auto |
$953.60
|
| Rate for Payer: Zelis Worker's Compensation |
$650.83
|
|
|
INFLIXIMAB-DYYB 100 MG VIAL PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT Q5103
|
| Hospital Charge Code |
3303159
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$39.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.99
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$21.99
|
| Rate for Payer: GEHA Medicare |
$19.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$21.99
|
| Rate for Payer: Humana Medicare Advantage |
$19.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$33.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.99
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.98
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.98
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.99
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$16.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.99
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
INFLIXIMAB-DYYB 100 MG VIAL PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT Q5103
|
| Hospital Charge Code |
3303159
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
INFLIXIMAB-DYYB 550 MG/NS 250 ML PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3303158
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
INFLIXIMAB-DYYB 550 MG/NS 250 ML PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3303158
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
INFLUENZA A /B pcr Cepheid AGH
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
2200771
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$136.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$130.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$95.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$105.38
|
| Rate for Payer: Humana Medicare Advantage |
$95.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$160.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$139.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$95.80
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.86
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$160.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$139.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$95.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$191.60
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$93.88
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$95.80
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$81.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.96
|
| Rate for Payer: Zelis Worker's Compensation |
$92.40
|
|
|
INFLUENZA A /B pcr Cepheid AGH
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
2200771
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$130.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$92.40
|
|
|
INFLUENZA VACCINE
|
Facility
|
IP
|
$239.50
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
3300357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.38 |
| Max. Negotiated Rate |
$227.53 |
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$203.57
|
| Rate for Payer: First Health Commercial |
$215.55
|
| Rate for Payer: First Health Workers Compensation |
$92.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.55
|
| Rate for Payer: GEHA Commercial |
$167.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.55
|
| Rate for Payer: Multiplan All |
$217.94
|
| Rate for Payer: OMNI Networks Commercial |
$167.65
|
| Rate for Payer: One Health Plan PPO/POS |
$215.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.53
|
| Rate for Payer: Three Rivers Provider Network All |
$179.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.74
|
| Rate for Payer: Zelis Auto |
$95.80
|
| Rate for Payer: Zelis Worker's Compensation |
$65.38
|
|
|
INFLUENZA VACCINE
|
Facility
|
OP
|
$239.50
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
3300357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$227.53 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$36.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$36.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.80
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$203.57
|
| Rate for Payer: First Health Commercial |
$215.55
|
| Rate for Payer: First Health Workers Compensation |
$92.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.55
|
| Rate for Payer: GEHA Commercial |
$25.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.55
|
| Rate for Payer: Humana ChoiceCare |
$62.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.39
|
| Rate for Payer: Multiplan All |
$217.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.70
|
| Rate for Payer: OMNI Networks Commercial |
$167.65
|
| Rate for Payer: One Health Plan PPO/POS |
$215.55
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$33.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.53
|
| Rate for Payer: Three Rivers Provider Network All |
$179.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.74
|
| Rate for Payer: Zelis Auto |
$95.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.75
|
| Rate for Payer: Zelis Worker's Compensation |
$65.38
|
|
|
INFUS NORMAL SALINE SOL 1000 CC
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT J7030
|
| Hospital Charge Code |
8507030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$2.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
INFUS NORMAL SALINE SOL 1000 CC
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT J7030
|
| Hospital Charge Code |
8507030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
inhibin a ultrasensitive REF146803
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
22990362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$51.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$237.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.13
|
|
|
inhibin a ultrasensitive REF146803
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
22990362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.59
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$51.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$271.20
|
| Rate for Payer: GEHA Medicare |
$15.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Humana ChoiceCare |
$17.15
|
| Rate for Payer: Humana Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.59
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.50
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$31.18
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.28
|
| Rate for Payer: United Healthcare Commercial |
$288.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.59
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Medicare |
$13.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.71
|
| Rate for Payer: Zelis Worker's Compensation |
$36.13
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
21600012
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$61.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$111.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Worker's Compensation |
$43.41
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
25500012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$61.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$127.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$43.41
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
25500012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$61.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$111.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Worker's Compensation |
$43.41
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
9390471
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
9390471
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
21500012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
21600012
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$61.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$127.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$43.41
|
|
|
INITIAL ADMINISTRATION
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
21500012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
INITIAL NRSNG FAC CARE SF/LOW MDM 25 MIN
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
8599304
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$71.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$242.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$137.50
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
INITIAL NRSNG FAC CARE SF/LOW MDM 25 MIN
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
8599304
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| 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 |
$106.18
|
| 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 |
$75.08
|
|
|
INITIAL NRSNG FAC CARE SF/LOW MDM 25 MIN
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
1900046
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
