|
IV INJECTION ACU
|
Facility
|
OP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
6180016
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$400.12 |
| 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 |
$244.53
|
| 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 |
$200.06
|
| Rate for Payer: Cash Price |
$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: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| 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 |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| 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 |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$346.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
IV INJ SAME DRUG
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
6180042
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
IV INJ SAME DRUG
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
6180042
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$249.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Humana ChoiceCare |
$81.12
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$187.20
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.56
|
| Rate for Payer: United Healthcare Commercial |
$265.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
24700006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$23.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$49.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Humana ChoiceCare |
$16.12
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.20
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$54.56
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$31.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.93
|
|
|
IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
24500006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$23.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$43.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.93
|
|
|
IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
24700006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$23.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$43.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.93
|
|
|
IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
24500006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: First Health Commercial |
$55.80
|
| Rate for Payer: First Health Workers Compensation |
$23.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$55.80
|
| Rate for Payer: GEHA Commercial |
$49.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$55.80
|
| Rate for Payer: Humana ChoiceCare |
$16.12
|
| Rate for Payer: Multiplan All |
$56.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.20
|
| Rate for Payer: OMNI Networks Commercial |
$43.40
|
| Rate for Payer: One Health Plan PPO/POS |
$55.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$58.90
|
| Rate for Payer: Three Rivers Provider Network All |
$46.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$54.56
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$57.66
|
| Rate for Payer: Zelis Auto |
$24.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$31.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.93
|
|
|
IV - NS 3% (HYPERTONIC SALINE)
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
3301182
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
IV - NS 3% (HYPERTONIC SALINE)
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
3301182
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
IVP, EA ADD'L SAME DRUG
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
8196376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$249.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Humana ChoiceCare |
$81.12
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$187.20
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
IVP, EA ADD'L SAME DRUG
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
8196376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
IVP INJ NEW/DIFF
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
6180030
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$186.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
IVP INJ NEW/DIFF
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
6180030
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$252.70 |
| 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 |
$159.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| 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 |
$242.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| 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 |
$252.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
| 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 |
$247.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
IVP, NEW DRUG, ADD ON
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8196375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$252.70 |
| 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 |
$159.60
|
| 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 |
$43.81
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| 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 |
$242.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| 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 |
$252.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| 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 |
$247.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
IVP, NEW DRUG, ADD ON
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
8196375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$186.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
IVP, SNGL/INIT DRUG
|
Facility
|
OP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8196374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$400.12 |
| 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 |
$244.53
|
| 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 |
$200.06
|
| Rate for Payer: Cash Price |
$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: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| 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 |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| 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 |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
IVP, SNGL/INIT DRUG
|
Facility
|
IP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
8196374
|
|
Hospital Revenue Code
|
450
|
| 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 SETS/TUBING
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 00264914250
|
| Hospital Charge Code |
3300471
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$32.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
IV SETS/TUBING
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 00264914250
|
| Hospital Charge Code |
3300471
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$37.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
IV THERAPY 1ST HOUR
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
6180017
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$648.85 |
| 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 |
$409.80
|
| 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 |
$409.80
|
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$546.40
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| 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 |
$621.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| 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 |
$648.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$580.55
|
| 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 |
$635.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
|
IV THERAPY 1ST HOUR
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
6180017
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$478.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| Rate for Payer: Multiplan All |
$621.53
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$648.85
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$635.19
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
|
IV THERAPY EA AD HR
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
6180018
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
IV THERAPY EA AD HR
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
6180018
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$235.60 |
| 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 |
$148.80
|
| 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 |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| 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 |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| 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 |
$235.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$210.80
|
| 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 |
$230.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
IV THERAPY SEQ HR
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
6180041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
IV THERAPY SEQ HR
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
6180041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$498.75 |
| 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 |
$315.00
|
| 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 |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| 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 |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| 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 |
$498.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Commercial |
$446.25
|
| 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 |
$488.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
