|
IV TX HYD 1ST HR
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
6180031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$600.40 |
| 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 |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
|
IV TX HYD 1ST HR
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
6180031
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
IV TX HYD EA AD HR
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
6180020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$229.90 |
| 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 |
$145.20
|
| 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 |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| 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 |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| 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 |
$229.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| 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 |
$225.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
IV TX HYD EA AD HR
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
6180020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
jak2 exons 12-15 REF115101
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 81279
|
| Hospital Charge Code |
2200700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.14 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$394.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Worker's Compensation |
$150.14
|
|
|
jak2 exons 12-15 REF115101
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 81279
|
| Hospital Charge Code |
2200700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.14 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$277.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$277.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$220.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$451.20
|
| Rate for Payer: GEHA Medicare |
$185.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Humana ChoiceCare |
$203.72
|
| Rate for Payer: Humana Medicare Advantage |
$185.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$311.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$224.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$185.20
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$314.84
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$259.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$224.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$185.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$370.40
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$479.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$185.20
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Medicare |
$157.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$222.24
|
| Rate for Payer: Zelis Worker's Compensation |
$150.14
|
|
|
jak2v617f mutation ana qualrflxREF489420
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
2200613
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.91 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$164.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$355.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$164.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$130.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$137.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$473.60
|
| Rate for Payer: GEHA Medicare |
$91.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Humana ChoiceCare |
$100.83
|
| Rate for Payer: Humana Medicare Advantage |
$91.66
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$153.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$133.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$91.66
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$155.82
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$153.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$133.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$91.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$183.32
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.83
|
| Rate for Payer: United Healthcare Commercial |
$503.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$91.66
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Medicare |
$77.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.99
|
| Rate for Payer: Zelis Worker's Compensation |
$97.19
|
|
|
jak2v617f mutation ana qualrflxREF489420
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
2200613
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$97.19 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$137.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Worker's Compensation |
$97.19
|
|
|
jak2 v617f mutation quant REF481020
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
2299330
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$97.19 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$137.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Worker's Compensation |
$97.19
|
|
|
jak2 v617f mutation quant REF481020
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
2299330
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.91 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$164.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$355.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$164.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$130.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$137.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$473.60
|
| Rate for Payer: GEHA Medicare |
$91.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Humana ChoiceCare |
$100.83
|
| Rate for Payer: Humana Medicare Advantage |
$91.66
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$153.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$133.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$91.66
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$155.82
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$153.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$133.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$91.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$183.32
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.83
|
| Rate for Payer: United Healthcare Commercial |
$503.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$91.66
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Medicare |
$77.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.99
|
| Rate for Payer: Zelis Worker's Compensation |
$97.19
|
|
|
jc polyoma virus dna rt pcr REF139370
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2299715
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$42.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$47.12
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$71.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.84
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.83
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$85.68
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.98
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.84
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$36.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.41
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
jc polyoma virus dna rt pcr REF139370
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
2299715
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
jo-1 antibody REF161455
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2299119
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
jo-1 antibody REF161455
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2299119
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
JOINT JACK SPLINT
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8230086
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$138.34
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$141.16
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.80
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$162.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$141.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.50
|
|
|
JOINT JACK SPLINT
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8800028
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$174.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$138.34
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$141.16
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.80
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$162.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$141.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.50
|
|
|
JOINT JACK SPLINT
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8800028
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
|
|
JOINT JACK SPLINT
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
8230086
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
|
|
JUST LIKE
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
3302517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
JUST LIKE
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
3302517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
KENALOG 40MG/ML INJ
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
3300918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$74.80
|
| Rate for Payer: First Health Commercial |
$79.20
|
| Rate for Payer: First Health Workers Compensation |
$33.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.20
|
| Rate for Payer: GEHA Commercial |
$0.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.20
|
| Rate for Payer: Humana ChoiceCare |
$22.88
|
| Rate for Payer: Multiplan All |
$80.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.80
|
| Rate for Payer: OMNI Networks Commercial |
$61.60
|
| Rate for Payer: One Health Plan PPO/POS |
$79.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$83.60
|
| Rate for Payer: Three Rivers Provider Network All |
$66.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$77.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$81.84
|
| Rate for Payer: Zelis Auto |
$35.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.02
|
|
|
KENALOG 40MG/ML INJ
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
3300918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$74.80
|
| Rate for Payer: First Health Commercial |
$79.20
|
| Rate for Payer: First Health Workers Compensation |
$33.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.20
|
| Rate for Payer: GEHA Commercial |
$61.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.20
|
| Rate for Payer: Multiplan All |
$80.08
|
| Rate for Payer: OMNI Networks Commercial |
$61.60
|
| Rate for Payer: One Health Plan PPO/POS |
$79.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$83.60
|
| Rate for Payer: Three Rivers Provider Network All |
$66.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$81.84
|
| Rate for Payer: Zelis Auto |
$35.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.02
|
|
|
kentucky bluegrass IgE REF602496
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
kentucky bluegrass IgE REF602496
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
KETAMINE 100MG/ML - 5ML VIAL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
NDC 67457010810
|
| Hospital Charge Code |
3301738
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
