|
IV INFUSION HYDRATION INITIAL 31 MIN-1 H
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
24700001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
IV INFUSION HYDRATION INITIAL 31 MIN-1 H
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
21600137
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$89.94 |
| Max. Negotiated Rate |
$531.05 |
| 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 |
$335.40
|
| 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 |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| 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 |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| 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 |
$531.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| 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 |
$519.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
IV INFUSION HYDRATION INITIAL 31 MIN-1 H
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
24500001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
IV INFUSION HYDRATION INITIAL 31 MIN-1 H
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
21600137
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$391.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24700003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$400.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$175.95
|
| Rate for Payer: First Health Commercial |
$186.30
|
| Rate for Payer: First Health Workers Compensation |
$79.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$186.30
|
| Rate for Payer: GEHA Commercial |
$165.60
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$186.30
|
| 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 |
$153.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$188.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$144.90
|
| Rate for Payer: One Health Plan PPO/POS |
$186.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$177.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$153.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$196.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$155.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$175.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$192.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$82.80
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$56.51
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
21600139
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$443.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
21600139
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$380.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$507.20
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| 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 |
$153.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$177.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$153.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24700003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$175.95
|
| Rate for Payer: First Health Commercial |
$186.30
|
| Rate for Payer: First Health Workers Compensation |
$79.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$186.30
|
| Rate for Payer: GEHA Commercial |
$144.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$186.30
|
| Rate for Payer: Multiplan All |
$188.37
|
| Rate for Payer: OMNI Networks Commercial |
$144.90
|
| Rate for Payer: One Health Plan PPO/POS |
$186.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$196.65
|
| Rate for Payer: Three Rivers Provider Network All |
$155.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$192.51
|
| Rate for Payer: Zelis Auto |
$82.80
|
| Rate for Payer: Zelis Worker's Compensation |
$56.51
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
8596365
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$443.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
8596365
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$380.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$507.20
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| 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 |
$153.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$177.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$153.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24500003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$175.95
|
| Rate for Payer: First Health Commercial |
$186.30
|
| Rate for Payer: First Health Workers Compensation |
$79.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$186.30
|
| Rate for Payer: GEHA Commercial |
$144.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$186.30
|
| Rate for Payer: Multiplan All |
$188.37
|
| Rate for Payer: OMNI Networks Commercial |
$144.90
|
| Rate for Payer: One Health Plan PPO/POS |
$186.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$196.65
|
| Rate for Payer: Three Rivers Provider Network All |
$155.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$192.51
|
| Rate for Payer: Zelis Auto |
$82.80
|
| Rate for Payer: Zelis Worker's Compensation |
$56.51
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
24500003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$400.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$190.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$175.95
|
| Rate for Payer: First Health Commercial |
$186.30
|
| Rate for Payer: First Health Workers Compensation |
$79.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$186.30
|
| Rate for Payer: GEHA Commercial |
$165.60
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$186.30
|
| 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 |
$153.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$188.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$144.90
|
| Rate for Payer: One Health Plan PPO/POS |
$186.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$177.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$153.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$196.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$155.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$175.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$192.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$82.80
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$56.51
|
|
|
IV INFUSION THERAPY PROPHYLAXIS/DX EA HO
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24500004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
IV INFUSION THERAPY PROPHYLAXIS/DX EA HO
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24500004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
IV INFUSION THERAPY PROPHYLAXIS/DX EA HO
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24700004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
IV INFUSION THERAPY PROPHYLAXIS/DX EA HO
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
24700004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
IV INFUSION THER PROPH ADDL SEQUENTIAL T
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
24700005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$63.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
IV INFUSION THER PROPH ADDL SEQUENTIAL T
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
24500005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$63.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
IV INFUSION THER PROPH ADDL SEQUENTIAL T
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
24700005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$77.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
IV INFUSION THER PROPH ADDL SEQUENTIAL T
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
24500005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$77.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
IV INJECTION
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9200023
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$18.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$34.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Worker's Compensation |
$13.38
|
|
|
IV INJECTION
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9200023
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$18.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$46.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$13.38
|
|
|
IV INJECTION ACU
|
Facility
|
IP
|
$407.55
|
|
| Hospital Charge Code |
6180029
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$387.17 |
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cigna Commercial |
$346.42
|
| Rate for Payer: First Health Commercial |
$366.80
|
| Rate for Payer: First Health Workers Compensation |
$157.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.80
|
| Rate for Payer: GEHA Commercial |
$285.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
IV INJECTION ACU
|
Facility
|
IP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
6180016
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$387.17 |
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cigna Commercial |
$346.42
|
| Rate for Payer: First Health Commercial |
$366.80
|
| Rate for Payer: First Health Workers Compensation |
$157.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.80
|
| Rate for Payer: GEHA Commercial |
$285.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
IV INJECTION ACU
|
Facility
|
OP
|
$407.55
|
|
| Hospital Charge Code |
6180029
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.89 |
| Max. Negotiated Rate |
$387.17 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.53
|
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cigna Commercial |
$346.42
|
| Rate for Payer: First Health Commercial |
$366.80
|
| Rate for Payer: First Health Workers Compensation |
$157.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.80
|
| Rate for Payer: GEHA Commercial |
$326.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| Rate for Payer: Humana ChoiceCare |
$105.96
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.53
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$358.64
|
| Rate for Payer: United Healthcare Commercial |
$346.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$203.78
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
