|
LENGTHENING OF THIGH TENDONS
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT 27394
|
| Hospital Charge Code |
6127394
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.54 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$777.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,100.75
|
| Rate for Payer: First Health Commercial |
$1,165.50
|
| Rate for Payer: First Health Workers Compensation |
$500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,165.50
|
| Rate for Payer: GEHA Commercial |
$1,036.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,165.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,178.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$906.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,165.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,230.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$971.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,204.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$518.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$353.54
|
|
|
LENGTHEN METACARPAL/FINGER
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 26568
|
| Hospital Charge Code |
6126568
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.58 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: First Health Workers Compensation |
$689.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,250.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: Zelis Auto |
$714.40
|
| Rate for Payer: Zelis Worker's Compensation |
$487.58
|
|
|
LENGTHEN METACARPAL/FINGER
|
Facility
|
OP
|
$1,786.00
|
|
|
Service Code
|
CPT 26568
|
| Hospital Charge Code |
6126568
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.58 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,071.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: First Health Workers Compensation |
$689.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,428.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$714.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$487.58
|
|
|
LENGTHEN RADIUS OR ULNA
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
CPT 25391
|
| Hospital Charge Code |
6125391
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$559.65 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,230.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,230.00
|
| Rate for Payer: Cash Price |
$1,230.00
|
| Rate for Payer: Cigna Commercial |
$1,742.50
|
| Rate for Payer: First Health Commercial |
$1,845.00
|
| Rate for Payer: First Health Workers Compensation |
$791.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,845.00
|
| Rate for Payer: GEHA Commercial |
$1,640.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,845.00
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,865.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,435.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,845.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,947.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,537.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,906.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$820.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$559.65
|
|
|
LENGTHEN RADIUS OR ULNA
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
CPT 25391
|
| Hospital Charge Code |
6125391
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$559.65 |
| Max. Negotiated Rate |
$1,947.50 |
| Rate for Payer: Cash Price |
$1,230.00
|
| Rate for Payer: Cigna Commercial |
$1,742.50
|
| Rate for Payer: First Health Commercial |
$1,845.00
|
| Rate for Payer: First Health Workers Compensation |
$791.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,845.00
|
| Rate for Payer: GEHA Commercial |
$1,435.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,845.00
|
| Rate for Payer: Multiplan All |
$1,865.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,435.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,845.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,947.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,537.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,906.50
|
| Rate for Payer: Zelis Auto |
$820.00
|
| Rate for Payer: Zelis Worker's Compensation |
$559.65
|
|
|
LENGTHEN RADIUS & ULNA
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
CPT 25393
|
| Hospital Charge Code |
6125393
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$633.36 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cigna Commercial |
$1,972.00
|
| Rate for Payer: First Health Commercial |
$2,088.00
|
| Rate for Payer: First Health Workers Compensation |
$895.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,088.00
|
| Rate for Payer: GEHA Commercial |
$1,624.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,088.00
|
| Rate for Payer: Multiplan All |
$2,111.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,624.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,088.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,204.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,740.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,157.60
|
| Rate for Payer: Zelis Auto |
$928.00
|
| Rate for Payer: Zelis Worker's Compensation |
$633.36
|
|
|
LENGTHEN RADIUS & ULNA
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
CPT 25393
|
| Hospital Charge Code |
6125393
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$633.36 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,392.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cigna Commercial |
$1,972.00
|
| Rate for Payer: First Health Commercial |
$2,088.00
|
| Rate for Payer: First Health Workers Compensation |
$895.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,088.00
|
| Rate for Payer: GEHA Commercial |
$1,856.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,088.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,111.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,624.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,088.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,204.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,740.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,157.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$928.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$633.36
|
|
|
Leptin 146712
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$195.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
Leptin 146712
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
LESION REMOVAL COLONOSCOPY
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
8545383
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,184.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$510.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,184.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$938.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cigna Commercial |
$723.35
|
| Rate for Payer: First Health Commercial |
$765.90
|
| Rate for Payer: First Health Workers Compensation |
$328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.90
|
| Rate for Payer: GEHA Commercial |
$680.80
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.90
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$957.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$774.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$595.70
|
| Rate for Payer: One Health Plan PPO/POS |
$765.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,105.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$957.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$808.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$638.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$957.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$791.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$340.40
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$232.32
|
|
|
LESION REMOVAL COLONOSCOPY
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
8545383
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$808.45 |
| Rate for Payer: Cash Price |
$510.60
|
| Rate for Payer: Cigna Commercial |
$723.35
|
| Rate for Payer: First Health Commercial |
$765.90
|
| Rate for Payer: First Health Workers Compensation |
$328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.90
|
| Rate for Payer: GEHA Commercial |
$595.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.90
|
| Rate for Payer: Multiplan All |
$774.41
|
| Rate for Payer: OMNI Networks Commercial |
$595.70
|
| Rate for Payer: One Health Plan PPO/POS |
$765.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$808.45
|
| Rate for Payer: Three Rivers Provider Network All |
$638.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$791.43
|
| Rate for Payer: Zelis Auto |
$340.40
|
| Rate for Payer: Zelis Worker's Compensation |
$232.32
|
|
|
LESION REMOVAL COLONOSCOPY
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
6145385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.22 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$488.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cigna Commercial |
$691.90
|
| Rate for Payer: First Health Commercial |
$732.60
|
| Rate for Payer: First Health Workers Compensation |
$314.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$732.60
|
| Rate for Payer: GEHA Commercial |
$651.20
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$732.60
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$740.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$569.80
|
| Rate for Payer: One Health Plan PPO/POS |
$732.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$773.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$610.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$325.60
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$222.22
|
|
|
LESION REMOVAL COLONOSCOPY
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
6145385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.22 |
| Max. Negotiated Rate |
$773.30 |
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cigna Commercial |
$691.90
|
| Rate for Payer: First Health Commercial |
$732.60
|
| Rate for Payer: First Health Workers Compensation |
$314.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$732.60
|
| Rate for Payer: GEHA Commercial |
$569.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$732.60
|
| Rate for Payer: Multiplan All |
$740.74
|
| Rate for Payer: OMNI Networks Commercial |
$569.80
|
| Rate for Payer: One Health Plan PPO/POS |
$732.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$773.30
|
| Rate for Payer: Three Rivers Provider Network All |
$610.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.02
|
| Rate for Payer: Zelis Auto |
$325.60
|
| Rate for Payer: Zelis Worker's Compensation |
$222.22
|
|
|
LETROZOLE 2.5 MG TAB
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
3302952
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
LETROZOLE 2.5 MG TAB
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
3302952
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
LETS KIT
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
NDC 51552134501
|
| Hospital Charge Code |
3303263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.75 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$299.40
|
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$399.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| Rate for Payer: Humana ChoiceCare |
$129.74
|
| Rate for Payer: Multiplan All |
$454.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$299.40
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$474.05
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$439.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$464.07
|
| Rate for Payer: Zelis Auto |
$199.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$249.50
|
| Rate for Payer: Zelis Worker's Compensation |
$136.23
|
|
|
LETS KIT
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
NDC 51552134501
|
| Hospital Charge Code |
3303263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$349.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| Rate for Payer: Multiplan All |
$454.09
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$474.05
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$464.07
|
| Rate for Payer: Zelis Auto |
$199.60
|
| Rate for Payer: Zelis Worker's Compensation |
$136.23
|
|
|
L.E.T. SPRAY 1 EACH KIT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
NDC 63323048527
|
| Hospital Charge Code |
3300485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
L.E.T. SPRAY 1 EACH KIT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 63323048527
|
| Hospital Charge Code |
3300485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
LEUPROLIDE ACETATE 22.5MG IM ONLY KIT
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
3300498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.88 |
| Max. Negotiated Rate |
$3,460.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,220.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,138.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,220.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$966.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$1,612.45
|
| Rate for Payer: First Health Commercial |
$1,707.30
|
| Rate for Payer: First Health Workers Compensation |
$732.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,707.30
|
| Rate for Payer: GEHA Commercial |
$1,903.35
|
| Rate for Payer: GEHA Medicare |
$1,730.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,707.30
|
| Rate for Payer: Humana ChoiceCare |
$1,903.35
|
| Rate for Payer: Humana Medicare Advantage |
$1,730.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,906.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$986.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,730.32
|
| Rate for Payer: Multiplan All |
$1,726.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,941.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,327.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,707.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,138.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$986.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,730.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,802.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,460.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,422.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,695.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$986.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,730.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,764.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,730.32
|
| Rate for Payer: Zelis Auto |
$758.80
|
| Rate for Payer: Zelis Medicare |
$1,470.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,076.38
|
| Rate for Payer: Zelis Worker's Compensation |
$517.88
|
|
|
LEUPROLIDE ACETATE 22.5MG IM ONLY KIT
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
3300498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.88 |
| Max. Negotiated Rate |
$1,802.15 |
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$1,612.45
|
| Rate for Payer: First Health Commercial |
$1,707.30
|
| Rate for Payer: First Health Workers Compensation |
$732.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,707.30
|
| Rate for Payer: GEHA Commercial |
$1,327.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,707.30
|
| Rate for Payer: Multiplan All |
$1,726.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,327.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,707.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,802.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,422.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,764.21
|
| Rate for Payer: Zelis Auto |
$758.80
|
| Rate for Payer: Zelis Worker's Compensation |
$517.88
|
|
|
LEVALBUTEROL 0.63MG/3ML HHN
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 76204080011
|
| Hospital Charge Code |
3300499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
LEVALBUTEROL 0.63MG/3ML HHN
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 76204080011
|
| Hospital Charge Code |
3300499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
LEVALBUTEROL 1.25MG/3ML HHN
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 76204090011
|
| Hospital Charge Code |
3300500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
LEVALBUTEROL 1.25MG/3ML HHN
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 76204090011
|
| Hospital Charge Code |
3300500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
