|
MORPHINE SULF 5 MG/ML INJ
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3301239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
MORPHINE SULFATE 10 MG/ML INJ
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3300614
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MORPHINE SULFATE 10 MG/ML INJ
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3300614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| 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: 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 |
$2.40
|
| 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
|
|
|
MORPHINE SULFATE 2MG/ML INJ
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3301238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| 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: 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 |
$2.40
|
| 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
|
|
|
MORPHINE SULFATE 2MG/ML INJ
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3301238
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MORPHINE SULFATE 4MG/ML INJ
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3302567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
MORPHINE SULFATE 4MG/ML INJ
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3302567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
MORPHINE SULFATE 8MG/ML INJECTION
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3302568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
MORPHINE SULFATE 8MG/ML INJECTION
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3302568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
mouse urine igE REF 602689
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299632
|
|
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
|
|
|
mouse urine igE REF 602689
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299632
|
|
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
|
|
|
MOXIFLOXACIN IVPB : 400MG/250ML NF
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT J2280
|
| Hospital Charge Code |
3301858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| 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: 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 |
$9.92
|
| 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
|
|
|
MOXIFLOXACIN IVPB : 400MG/250ML NF
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT J2280
|
| Hospital Charge Code |
3301858
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
mpl mutation analysis REF489150
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
2300026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.23 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$170.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.23
|
|
|
mpl mutation analysis REF489150
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
2300026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.23 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$270.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$270.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$150.33
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$170.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: GEHA Medicare |
$150.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$165.36
|
| Rate for Payer: Humana Medicare Advantage |
$150.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$252.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$218.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$150.33
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$255.56
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$252.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$218.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$150.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$300.66
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$147.32
|
| Rate for Payer: United Healthcare Commercial |
$711.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$150.33
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Medicare |
$127.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.40
|
| Rate for Payer: Zelis Worker's Compensation |
$120.23
|
|
|
MPL MUTATION QUAL
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
2200077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.23 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$270.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$270.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$150.33
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$170.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: GEHA Medicare |
$150.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$165.36
|
| Rate for Payer: Humana Medicare Advantage |
$150.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$252.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$218.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$150.33
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$255.56
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$252.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$218.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$150.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$300.66
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$147.32
|
| Rate for Payer: United Healthcare Commercial |
$711.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$150.33
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Medicare |
$127.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.40
|
| Rate for Payer: Zelis Worker's Compensation |
$120.23
|
|
|
MPL MUTATION QUAL
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
2200077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.23 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$170.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.23
|
|
|
mpo anti myeloperoxidase REF123006
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 83876
|
| Hospital Charge Code |
2200734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: First Health Commercial |
$221.40
|
| Rate for Payer: First Health Workers Compensation |
$57.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$221.40
|
| Rate for Payer: GEHA Commercial |
$172.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$221.40
|
| Rate for Payer: Multiplan All |
$223.86
|
| Rate for Payer: OMNI Networks Commercial |
$172.20
|
| Rate for Payer: One Health Plan PPO/POS |
$221.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$233.70
|
| Rate for Payer: Three Rivers Provider Network All |
$184.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$228.78
|
| Rate for Payer: Zelis Auto |
$98.40
|
| Rate for Payer: Zelis Worker's Compensation |
$40.63
|
|
|
mpo anti myeloperoxidase REF123006
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 83876
|
| Hospital Charge Code |
2200734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: First Health Commercial |
$221.40
|
| Rate for Payer: First Health Workers Compensation |
$57.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$221.40
|
| Rate for Payer: GEHA Commercial |
$196.80
|
| Rate for Payer: GEHA Medicare |
$50.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$221.40
|
| Rate for Payer: Humana ChoiceCare |
$55.95
|
| Rate for Payer: Humana Medicare Advantage |
$50.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$85.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$50.86
|
| Rate for Payer: Multiplan All |
$223.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.46
|
| Rate for Payer: OMNI Networks Commercial |
$172.20
|
| Rate for Payer: One Health Plan PPO/POS |
$221.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$233.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$101.72
|
| Rate for Payer: Three Rivers Provider Network All |
$184.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.84
|
| Rate for Payer: United Healthcare Commercial |
$209.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$228.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$50.86
|
| Rate for Payer: Zelis Auto |
$98.40
|
| Rate for Payer: Zelis Medicare |
$43.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.03
|
| Rate for Payer: Zelis Worker's Compensation |
$40.63
|
|
|
MRA ABD W/CON
|
Facility
|
OP
|
$3,712.00
|
|
|
Service Code
|
CPT C8900
|
| Hospital Charge Code |
2000187
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,526.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,227.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cigna Commercial |
$3,155.20
|
| Rate for Payer: First Health Commercial |
$3,340.80
|
| Rate for Payer: First Health Workers Compensation |
$1,433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,340.80
|
| Rate for Payer: GEHA Commercial |
$2,969.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,340.80
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,377.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,598.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,340.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,526.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,784.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,155.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,452.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,484.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$1,013.38
|
|
|
MRA ABD W/CON
|
Facility
|
IP
|
$3,712.00
|
|
|
Service Code
|
CPT C8900
|
| Hospital Charge Code |
2000187
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,013.38 |
| Max. Negotiated Rate |
$3,526.40 |
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cigna Commercial |
$3,155.20
|
| Rate for Payer: First Health Commercial |
$3,340.80
|
| Rate for Payer: First Health Workers Compensation |
$1,433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,340.80
|
| Rate for Payer: GEHA Commercial |
$2,598.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,340.80
|
| Rate for Payer: Multiplan All |
$3,377.92
|
| Rate for Payer: OMNI Networks Commercial |
$2,598.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,340.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,526.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,784.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,452.16
|
| Rate for Payer: Zelis Auto |
$1,484.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,013.38
|
|
|
MRA CHEST W/C
|
Facility
|
IP
|
$3,843.00
|
|
|
Service Code
|
CPT C8909
|
| Hospital Charge Code |
2000189
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,049.14 |
| Max. Negotiated Rate |
$3,650.85 |
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cigna Commercial |
$3,266.55
|
| Rate for Payer: First Health Commercial |
$3,458.70
|
| Rate for Payer: First Health Workers Compensation |
$1,483.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,458.70
|
| Rate for Payer: GEHA Commercial |
$2,690.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,458.70
|
| Rate for Payer: Multiplan All |
$3,497.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,690.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,458.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,650.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,882.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,573.99
|
| Rate for Payer: Zelis Auto |
$1,537.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,049.14
|
|
|
MRA CHEST W/C
|
Facility
|
OP
|
$3,843.00
|
|
|
Service Code
|
CPT C8909
|
| Hospital Charge Code |
2000189
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,650.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,305.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cigna Commercial |
$3,266.55
|
| Rate for Payer: First Health Commercial |
$3,458.70
|
| Rate for Payer: First Health Workers Compensation |
$1,483.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,458.70
|
| Rate for Payer: GEHA Commercial |
$3,074.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,458.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,497.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,690.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,458.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,650.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,882.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,266.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,573.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,537.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$1,049.14
|
|
|
MRA HEAD W/CON
|
Facility
|
OP
|
$4,178.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
2000160
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,969.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,506.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$3,551.30
|
| Rate for Payer: First Health Commercial |
$3,760.20
|
| Rate for Payer: First Health Workers Compensation |
$636.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,760.20
|
| Rate for Payer: GEHA Commercial |
$3,342.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,760.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,801.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,924.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,760.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,551.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,885.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,671.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$449.73
|
|
|
MRA HEAD W/CON
|
Facility
|
IP
|
$4,178.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
2000160
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$449.73 |
| Max. Negotiated Rate |
$3,969.10 |
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$3,551.30
|
| Rate for Payer: First Health Commercial |
$3,760.20
|
| Rate for Payer: First Health Workers Compensation |
$636.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,760.20
|
| Rate for Payer: GEHA Commercial |
$2,924.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,760.20
|
| Rate for Payer: Multiplan All |
$3,801.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,924.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,760.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,969.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,885.54
|
| Rate for Payer: Zelis Auto |
$1,671.20
|
| Rate for Payer: Zelis Worker's Compensation |
$449.73
|
|
