|
INS STABL DEV WO DCMPRN
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 22870
|
| Hospital Charge Code |
6191087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INST AWL JUGGERKNOT GUIDE 2.9MM
|
Facility
|
IP
|
$2,117.00
|
|
| Hospital Charge Code |
7000209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$846.80 |
| Max. Negotiated Rate |
$2,011.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,693.60
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cigna Commercial |
$1,799.45
|
| Rate for Payer: First Health Commercial |
$1,905.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,905.30
|
| Rate for Payer: GEHA Commercial |
$1,481.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,905.30
|
| Rate for Payer: Multiplan All |
$1,926.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,905.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,011.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,968.81
|
| Rate for Payer: Zelis Auto |
$846.80
|
|
|
INST AWL JUGGERKNOT GUIDE 2.9MM
|
Facility
|
OP
|
$2,117.00
|
|
| Hospital Charge Code |
7000209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.25 |
| Max. Negotiated Rate |
$2,011.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cigna Commercial |
$1,799.45
|
| Rate for Payer: First Health Commercial |
$1,905.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,905.30
|
| Rate for Payer: GEHA Commercial |
$1,693.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,905.30
|
| Rate for Payer: Humana ChoiceCare |
$550.42
|
| Rate for Payer: Multiplan All |
$1,926.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,270.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,905.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,011.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,862.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$529.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,968.81
|
| Rate for Payer: Zelis Auto |
$846.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,058.50
|
|
|
INST AWL,ZIP,5MM
|
Facility
|
IP
|
$895.00
|
|
| Hospital Charge Code |
7000210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: First Health Workers Compensation |
$345.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Worker's Compensation |
$244.34
|
|
|
INST AWL,ZIP,5MM
|
Facility
|
OP
|
$895.00
|
|
| Hospital Charge Code |
7000210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: First Health Workers Compensation |
$345.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
| Rate for Payer: Zelis Worker's Compensation |
$244.34
|
|
|
INST BIT DRILL ORTH 4.5MM
|
Facility
|
IP
|
$1,604.00
|
|
| Hospital Charge Code |
90020378
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$437.89 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna Commercial |
$1,363.40
|
| Rate for Payer: First Health Commercial |
$1,443.60
|
| Rate for Payer: First Health Workers Compensation |
$619.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,443.60
|
| Rate for Payer: GEHA Commercial |
$1,122.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,443.60
|
| Rate for Payer: Multiplan All |
$1,459.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,122.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,443.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,523.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,491.72
|
| Rate for Payer: Zelis Auto |
$641.60
|
| Rate for Payer: Zelis Worker's Compensation |
$437.89
|
|
|
INST BIT DRILL ORTH 4.5MM
|
Facility
|
OP
|
$1,604.00
|
|
| Hospital Charge Code |
90020378
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$401.00 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna Commercial |
$1,363.40
|
| Rate for Payer: First Health Commercial |
$1,443.60
|
| Rate for Payer: First Health Workers Compensation |
$619.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,443.60
|
| Rate for Payer: GEHA Commercial |
$1,283.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,443.60
|
| Rate for Payer: Humana ChoiceCare |
$417.04
|
| Rate for Payer: Multiplan All |
$1,459.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$962.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,122.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,443.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,523.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,411.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$401.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,491.72
|
| Rate for Payer: Zelis Auto |
$641.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$802.00
|
| Rate for Payer: Zelis Worker's Compensation |
$437.89
|
|
|
INS TUN IP CATH FOR DIAL OPN
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 49421
|
| Hospital Charge Code |
6149421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,079.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,079.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,439.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$489.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,489.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,874.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,489.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,489.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
|
INS TUN IP CATH FOR DIAL OPN
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 49421
|
| Hospital Charge Code |
6149421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$428.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
|
insulin 2 hour REF312114
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
2233526
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$21.20
|
| 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 |
$14.99
|
|
|
insulin 2 hour REF312114
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
2233526
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.58
|
| 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 |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.43
|
| 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 |
$21.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$11.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$12.57
|
| Rate for Payer: Humana Medicare Advantage |
$11.43
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.43
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.43
|
| 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 |
$19.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$22.86
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.20
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.43
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$9.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.99
|
|
|
insulin abs REF141598
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
2200567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.08 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: First Health Workers Compensation |
$42.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$144.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.08
|
|
|
insulin abs REF141598
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
2200567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: First Health Workers Compensation |
$42.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$164.80
|
| Rate for Payer: GEHA Medicare |
$21.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Humana ChoiceCare |
$23.55
|
| Rate for Payer: Humana Medicare Advantage |
$21.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.41
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42.82
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.98
|
| Rate for Payer: United Healthcare Commercial |
$175.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.41
|
| Rate for Payer: Zelis Auto |
$82.40
|
| Rate for Payer: Zelis Medicare |
$18.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.69
|
| Rate for Payer: Zelis Worker's Compensation |
$30.08
|
|
|
INSULIN - humaLOG MIX 75-25 SUBQ
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
INSULIN - humaLOG MIX 75-25 SUBQ
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
insulin, human IgE REF602652
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200816
|
|
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
|
|
|
insulin, human IgE REF602652
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200816
|
|
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
|
|
|
INSULIN - HumuLIN MIX 70-30 SUBQ
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
INSULIN - HumuLIN MIX 70-30 SUBQ
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
INSULIN - HumuLIN NPH 100 UNITS/ML SUBQ
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
INSULIN - HumuLIN NPH 100 UNITS/ML SUBQ
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
INSULIN - HumuLIN R 100 UNITS/ML
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
INSULIN - HumuLIN R 100 UNITS/ML
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
INSULIN - LANTUS 100 UNITS/ML SUBQ
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300452
|
|
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
|
|
|
INSULIN - LANTUS 100 UNITS/ML SUBQ
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300452
|
|
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
|
|
