|
M/S INITIAL HYDRATION 31-60 MIN
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
1000001
|
|
Hospital Revenue Code
|
260
|
| 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 Commercial |
$537.20
|
| 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
|
|
|
M/S IV PUSH-INITIAL
|
Facility
|
IP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
1000008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$387.17 |
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cigna Commercial |
$346.42
|
| Rate for Payer: First Health Commercial |
$366.80
|
| Rate for Payer: First Health Workers Compensation |
$157.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.80
|
| Rate for Payer: GEHA Commercial |
$285.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
M/S IV PUSH-NEW DRUG
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
1000009
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$186.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
M/S IV PUSH-SAME DRUG
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
1000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
M/S IV PUSH-SAME DRUG
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
1000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$249.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Humana ChoiceCare |
$81.12
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$187.20
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.56
|
| Rate for Payer: United Healthcare Commercial |
$265.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
M/S SQ OR INTRAMUSCULAR INJECTION
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
1000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$137.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
M/S VACCINE ADMINISTRATION
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1000012
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
MT BONE GRAFT MICROVASC
|
Facility
|
OP
|
$5,078.00
|
|
|
Service Code
|
CPT 20957
|
| Hospital Charge Code |
6120957
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,269.50 |
| Max. Negotiated Rate |
$4,824.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,046.80
|
| Rate for Payer: Cash Price |
$3,046.80
|
| Rate for Payer: Cigna Commercial |
$4,316.30
|
| Rate for Payer: First Health Commercial |
$4,570.20
|
| Rate for Payer: First Health Workers Compensation |
$1,960.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,570.20
|
| Rate for Payer: GEHA Commercial |
$4,062.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,570.20
|
| Rate for Payer: Humana ChoiceCare |
$1,320.28
|
| Rate for Payer: Multiplan All |
$4,620.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,046.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,554.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,570.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,824.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,808.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,468.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,269.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,722.54
|
| Rate for Payer: Zelis Auto |
$2,031.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,539.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,386.29
|
|
|
MT BONE GRAFT MICROVASC
|
Facility
|
IP
|
$5,078.00
|
|
|
Service Code
|
CPT 20957
|
| Hospital Charge Code |
6120957
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,386.29 |
| Max. Negotiated Rate |
$4,824.10 |
| Rate for Payer: Cash Price |
$3,046.80
|
| Rate for Payer: Cigna Commercial |
$4,316.30
|
| Rate for Payer: First Health Commercial |
$4,570.20
|
| Rate for Payer: First Health Workers Compensation |
$1,960.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,570.20
|
| Rate for Payer: GEHA Commercial |
$3,554.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,570.20
|
| Rate for Payer: Multiplan All |
$4,620.98
|
| Rate for Payer: OMNI Networks Commercial |
$3,554.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,570.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,824.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,808.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,722.54
|
| Rate for Payer: Zelis Auto |
$2,031.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,386.29
|
|
|
mugwort IgE REF602531
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299152
|
|
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
|
|
|
mugwort IgE REF602531
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299152
|
|
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
|
|
|
mulberry white IgE REF602569
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299139
|
|
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
|
|
|
mulberry white IgE REF602569
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299139
|
|
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
|
|
|
mulberry white IgE REF 602569
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2210000
|
|
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
|
|
|
mulberry white IgE REF 602569
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2210000
|
|
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
|
|
|
MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP 1
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 97157
|
| Hospital Charge Code |
4397926
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP 1
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 97157
|
| Hospital Charge Code |
4397926
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$20.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$14.48
|
|
|
MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
9599237
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$72.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$84.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$72.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
9599237
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
8499237
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$72.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$84.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
8499237
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
MULTIPLE SURGERY ABDOMEN
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
CPT 49220
|
| Hospital Charge Code |
6149220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$461.00 |
| Max. Negotiated Rate |
$1,751.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,106.40
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$1,567.40
|
| Rate for Payer: First Health Commercial |
$1,659.60
|
| Rate for Payer: First Health Workers Compensation |
$711.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,659.60
|
| Rate for Payer: GEHA Commercial |
$1,475.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,659.60
|
| Rate for Payer: Humana ChoiceCare |
$479.44
|
| Rate for Payer: Multiplan All |
$1,678.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,106.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,290.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,659.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,751.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,383.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,622.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$461.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,714.92
|
| Rate for Payer: Zelis Auto |
$737.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$922.00
|
| Rate for Payer: Zelis Worker's Compensation |
$503.41
|
|
|
MULTIPLE SURGERY ABDOMEN
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
CPT 49220
|
| Hospital Charge Code |
6149220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$503.41 |
| Max. Negotiated Rate |
$1,751.80 |
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$1,567.40
|
| Rate for Payer: First Health Commercial |
$1,659.60
|
| Rate for Payer: First Health Workers Compensation |
$711.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,659.60
|
| Rate for Payer: GEHA Commercial |
$1,290.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,659.60
|
| Rate for Payer: Multiplan All |
$1,678.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,290.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,659.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,751.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,383.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,714.92
|
| Rate for Payer: Zelis Auto |
$737.60
|
| Rate for Payer: Zelis Worker's Compensation |
$503.41
|
|
|
MULTIPLE VITAMIN LIQUID
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 50383068304
|
| Hospital Charge Code |
3300623
|
|
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
|
|
|
MULTIPLE VITAMIN LIQUID
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 50383068304
|
| Hospital Charge Code |
3300623
|
|
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
|
|
