|
INSULIN - LEVEMIR 100 UNITS/ML SUBQ
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300451
|
|
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 - LEVEMIR 100 UNITS/ML SUBQ
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300451
|
|
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
|
|
|
INSULIN - LISPRO (HumaLOG)100 UNITS/ML
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300456
|
|
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 - LISPRO (HumaLOG)100 UNITS/ML
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300456
|
|
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 -novoLIN 70/30 SUBQ
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300454
|
|
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 -novoLIN 70/30 SUBQ
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300454
|
|
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 - NovoLOG 100 UNITS/ML SUBQ
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
INSULIN - NovoLOG 100 UNITS/ML SUBQ
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3300450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
insulin REF004333
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
2233525
|
|
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 REF004333
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
2233525
|
|
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 R (IV DRIP) 1ML
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3370003
|
|
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 R (IV DRIP) 1ML
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
3370003
|
|
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
|
|
|
INS URETERAL CTH/STN
|
Facility
|
OP
|
$2,860.00
|
|
| Hospital Charge Code |
2400340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$2,717.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,431.00
|
| Rate for Payer: First Health Commercial |
$2,574.00
|
| Rate for Payer: First Health Workers Compensation |
$1,104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,574.00
|
| Rate for Payer: GEHA Commercial |
$2,288.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,574.00
|
| Rate for Payer: Humana ChoiceCare |
$743.60
|
| Rate for Payer: Multiplan All |
$2,602.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,716.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,002.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,574.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,717.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,145.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,516.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$715.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,659.80
|
| Rate for Payer: Zelis Auto |
$1,144.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$780.78
|
|
|
INS URETERAL CTH/STN
|
Facility
|
IP
|
$2,860.00
|
|
| Hospital Charge Code |
2400340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.78 |
| Max. Negotiated Rate |
$2,717.00 |
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,431.00
|
| Rate for Payer: First Health Commercial |
$2,574.00
|
| Rate for Payer: First Health Workers Compensation |
$1,104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,574.00
|
| Rate for Payer: GEHA Commercial |
$2,002.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,574.00
|
| Rate for Payer: Multiplan All |
$2,602.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,002.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,574.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,717.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,145.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,659.80
|
| Rate for Payer: Zelis Auto |
$1,144.00
|
| Rate for Payer: Zelis Worker's Compensation |
$780.78
|
|
|
INS VAG BRACHYTX DEVICE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
6157156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$577.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$366.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$366.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$289.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$173.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$360.00
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$295.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$341.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$295.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$295.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$122.85
|
|
|
INS VAG BRACHYTX DEVICE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
6157156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$173.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$315.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Worker's Compensation |
$122.85
|
|
|
INTERDENTAL FIXATION
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
6121110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,292.00 |
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,156.00
|
| Rate for Payer: First Health Commercial |
$1,224.00
|
| Rate for Payer: First Health Workers Compensation |
$525.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.00
|
| Rate for Payer: GEHA Commercial |
$952.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.00
|
| Rate for Payer: Multiplan All |
$1,237.60
|
| Rate for Payer: OMNI Networks Commercial |
$952.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,264.80
|
| Rate for Payer: Zelis Auto |
$544.00
|
| Rate for Payer: Zelis Worker's Compensation |
$371.28
|
|
|
INTERDENTAL FIXATION
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
CPT 21110
|
| Hospital Charge Code |
6121110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$969.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$816.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$969.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$768.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,156.00
|
| Rate for Payer: First Health Commercial |
$1,224.00
|
| Rate for Payer: First Health Workers Compensation |
$525.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.00
|
| Rate for Payer: GEHA Commercial |
$1,088.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.00
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$783.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,237.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$952.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$904.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$783.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$783.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,264.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$544.00
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$371.28
|
|
|
INTERDENTAL WIRING
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
6121497
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.43 |
| Max. Negotiated Rate |
$1,163.75 |
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,041.25
|
| Rate for Payer: First Health Commercial |
$1,102.50
|
| Rate for Payer: First Health Workers Compensation |
$472.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,102.50
|
| Rate for Payer: GEHA Commercial |
$857.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,102.50
|
| Rate for Payer: Multiplan All |
$1,114.75
|
| Rate for Payer: OMNI Networks Commercial |
$857.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,102.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,163.75
|
| Rate for Payer: Three Rivers Provider Network All |
$918.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,139.25
|
| Rate for Payer: Zelis Auto |
$490.00
|
| Rate for Payer: Zelis Worker's Compensation |
$334.43
|
|
|
INTERDENTAL WIRING
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
6121497
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.43 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,041.25
|
| Rate for Payer: First Health Commercial |
$1,102.50
|
| Rate for Payer: First Health Workers Compensation |
$472.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,102.50
|
| Rate for Payer: GEHA Commercial |
$980.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,102.50
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,114.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$857.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,102.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,163.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$918.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,139.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$490.00
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$334.43
|
|
|
interferon bet neutralizing ab REF819067
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2299256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.41
|
| 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 |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.12
|
| 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 |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$14.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$15.53
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.12
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.00
|
| 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 |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.24
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.84
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.12
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.94
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
interferon bet neutralizing ab REF819067
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2299256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.81 |
| 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 |
$22.35
|
| 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 |
$15.81
|
|
|
interleukin-6, serum REF140916
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
interleukin-6, serum REF140916
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
INTERNAL NERVE REVISION
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 64727
|
| Hospital Charge Code |
6164727
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$1,892.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| 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 |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| 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 |
$223.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Humana ChoiceCare |
$150.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$347.40
|
| 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 |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$509.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.50
|
| Rate for Payer: Zelis Worker's Compensation |
$158.07
|
|
