|
IRRIGATION SPHENOID SINUS
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 31002
|
| Hospital Charge Code |
6131002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$464.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| 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 |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$232.00
|
| 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 |
$158.34
|
|
|
IRRIGATION SPHENOID SINUS
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 31002
|
| Hospital Charge Code |
6131002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$406.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: Zelis Auto |
$232.00
|
| Rate for Payer: Zelis Worker's Compensation |
$158.34
|
|
|
IR SUP PUBIC CATH INSERTION
|
Facility
|
IP
|
$7,820.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
2451102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$7,429.00 |
| Rate for Payer: Cash Price |
$4,692.00
|
| Rate for Payer: Cigna Commercial |
$6,647.00
|
| Rate for Payer: First Health Commercial |
$7,038.00
|
| Rate for Payer: First Health Workers Compensation |
$3,019.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,038.00
|
| Rate for Payer: GEHA Commercial |
$5,474.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,038.00
|
| Rate for Payer: Multiplan All |
$7,116.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,474.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,038.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,429.00
|
| Rate for Payer: Three Rivers Provider Network All |
$5,865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,272.60
|
| Rate for Payer: Zelis Auto |
$3,128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,134.86
|
|
|
IR SUP PUBIC CATH INSERTION
|
Facility
|
OP
|
$7,820.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
2451102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,603.92 |
| Max. Negotiated Rate |
$7,429.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,692.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,603.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$4,692.00
|
| Rate for Payer: Cash Price |
$4,692.00
|
| Rate for Payer: Cigna Commercial |
$6,647.00
|
| Rate for Payer: First Health Commercial |
$7,038.00
|
| Rate for Payer: First Health Workers Compensation |
$2,503.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,038.00
|
| Rate for Payer: GEHA Commercial |
$6,256.00
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,038.00
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,636.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$7,116.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$5,474.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,038.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,889.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,636.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,429.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$5,865.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,272.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$3,128.00
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,770.08
|
|
|
IR THORACENTESIS, W/O IMAGE GUIDE
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
7732554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: First Health Workers Compensation |
$755.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,784.00
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$892.00
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$534.22
|
|
|
IR THORACENTESIS, W/O IMAGE GUIDE
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
7732554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$608.79 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: First Health Workers Compensation |
$861.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,561.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
| Rate for Payer: Zelis Worker's Compensation |
$608.79
|
|
|
IR THYROID FINE NEEDLE 1ST LESION/US GUI
|
Facility
|
OP
|
$2,235.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
7778510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,341.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$688.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,788.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$702.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$811.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$702.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$702.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
IR THYROID FINE NEEDLE 1ST LESION/US GUI
|
Facility
|
IP
|
$2,235.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
7778510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$610.15 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: First Health Workers Compensation |
$862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,564.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Worker's Compensation |
$610.15
|
|
|
ISLAND PEDICLE FLAP GRAFT
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 15740
|
| Hospital Charge Code |
6115740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.57 |
| Max. Negotiated Rate |
$1,654.90 |
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cigna Commercial |
$1,480.70
|
| Rate for Payer: First Health Commercial |
$1,567.80
|
| Rate for Payer: First Health Workers Compensation |
$672.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,567.80
|
| Rate for Payer: GEHA Commercial |
$1,219.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,567.80
|
| Rate for Payer: Multiplan All |
$1,585.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,219.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,567.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,654.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,306.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.06
|
| Rate for Payer: Zelis Auto |
$696.80
|
| Rate for Payer: Zelis Worker's Compensation |
$475.57
|
|
|
ISLAND PEDICLE FLAP GRAFT
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 15740
|
| Hospital Charge Code |
6115740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.57 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,045.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cigna Commercial |
$1,480.70
|
| Rate for Payer: First Health Commercial |
$1,567.80
|
| Rate for Payer: First Health Workers Compensation |
$672.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,567.80
|
| Rate for Payer: GEHA Commercial |
$1,393.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,567.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,585.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,219.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,567.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,654.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,306.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$696.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$475.57
|
|
|
ISONIAZID 300 MG TAB
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
3302888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$1.70
|
| Rate for Payer: First Health Commercial |
$1.80
|
| Rate for Payer: First Health Workers Compensation |
$0.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1.80
|
| Rate for Payer: GEHA Commercial |
$1.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1.80
|
| Rate for Payer: Humana ChoiceCare |
$0.52
|
| Rate for Payer: Multiplan All |
$1.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.20
|
| Rate for Payer: OMNI Networks Commercial |
$1.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1.86
|
| Rate for Payer: Zelis Auto |
$0.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.55
|
|
|
ISONIAZID 300 MG TAB
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
3302888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$1.70
|
| Rate for Payer: First Health Commercial |
$1.80
|
| Rate for Payer: First Health Workers Compensation |
$0.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1.80
|
| Rate for Payer: GEHA Commercial |
$1.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1.80
|
| Rate for Payer: Multiplan All |
$1.82
|
| Rate for Payer: OMNI Networks Commercial |
$1.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1.86
|
| Rate for Payer: Zelis Auto |
$0.80
|
| Rate for Payer: Zelis Worker's Compensation |
$0.55
|
|
|
ISOSORBIDE DINITRATE 10MG TAB
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
3300468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
ISOSORBIDE DINITRATE 10MG TAB
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 68084008201
|
| Hospital Charge Code |
3300468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
ISOSORBIDE MONONITRATE 10MG TAB
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
3300469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
ISOSORBIDE MONONITRATE 10MG TAB
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 00904661961
|
| Hospital Charge Code |
3300469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
ISOSORBIDE MONONITRATE 30MG SR 24HR TAB
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
3300470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
ISOSORBIDE MONONITRATE 30MG SR 24HR TAB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00904644961
|
| Hospital Charge Code |
3300470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
ISOVUE 370 - 50ML VIAL - 76%
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Humana ChoiceCare |
$17.42
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.20
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.50
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
ISOVUE 370 - 50ML VIAL - 76%
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$46.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
ISOVUE-370 SOLN 76% - 100 ML BOTTLE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3302808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$44.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.12
|
|
|
ISOVUE-370 SOLN 76% - 100 ML BOTTLE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3302808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$44.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$29.64
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$68.40
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$57.00
|
| Rate for Payer: Zelis Worker's Compensation |
$31.12
|
|
|
IVERMECTIN 3 MG TAB
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
3303063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: First Health Commercial |
$31.50
|
| Rate for Payer: First Health Workers Compensation |
$13.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$31.50
|
| Rate for Payer: GEHA Commercial |
$24.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$31.50
|
| Rate for Payer: Multiplan All |
$31.85
|
| Rate for Payer: OMNI Networks Commercial |
$24.50
|
| Rate for Payer: One Health Plan PPO/POS |
$31.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$33.25
|
| Rate for Payer: Three Rivers Provider Network All |
$26.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$32.55
|
| Rate for Payer: Zelis Auto |
$14.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.55
|
|
|
IVERMECTIN 3 MG TAB
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
3303063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: First Health Commercial |
$31.50
|
| Rate for Payer: First Health Workers Compensation |
$13.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$31.50
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$31.50
|
| Rate for Payer: Humana ChoiceCare |
$9.10
|
| Rate for Payer: Multiplan All |
$31.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.00
|
| Rate for Payer: OMNI Networks Commercial |
$24.50
|
| Rate for Payer: One Health Plan PPO/POS |
$31.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$33.25
|
| Rate for Payer: Three Rivers Provider Network All |
$26.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$32.55
|
| Rate for Payer: Zelis Auto |
$14.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.50
|
| Rate for Payer: Zelis Worker's Compensation |
$9.55
|
|
|
IV HYDRA, 31 MINS TO 1 HR
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
8196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.94 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: First Health Workers Compensation |
$244.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Humana Medicare Advantage |
$200.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$336.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
