|
myomarker 3 plus profile REF520085
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
myomarker 3 plus profile REF520085
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
MYOMECTOMY ABDOM COMPLEX
|
Facility
|
OP
|
$2,338.00
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
6158146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$2,221.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,402.80
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cigna Commercial |
$1,987.30
|
| Rate for Payer: First Health Commercial |
$2,104.20
|
| Rate for Payer: First Health Workers Compensation |
$902.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,104.20
|
| Rate for Payer: GEHA Commercial |
$1,870.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,104.20
|
| Rate for Payer: Humana ChoiceCare |
$607.88
|
| Rate for Payer: Multiplan All |
$2,127.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,402.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,636.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,104.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,221.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,753.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,057.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$584.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,174.34
|
| Rate for Payer: Zelis Auto |
$935.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,169.00
|
| Rate for Payer: Zelis Worker's Compensation |
$638.27
|
|
|
MYOMECTOMY ABDOM COMPLEX
|
Facility
|
IP
|
$2,338.00
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
6158146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.27 |
| Max. Negotiated Rate |
$2,221.10 |
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cigna Commercial |
$1,987.30
|
| Rate for Payer: First Health Commercial |
$2,104.20
|
| Rate for Payer: First Health Workers Compensation |
$902.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,104.20
|
| Rate for Payer: GEHA Commercial |
$1,636.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,104.20
|
| Rate for Payer: Multiplan All |
$2,127.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,636.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,104.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,221.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,753.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,174.34
|
| Rate for Payer: Zelis Auto |
$935.20
|
| Rate for Payer: Zelis Worker's Compensation |
$638.27
|
|
|
MYOMECTOMY ABDOM METHOD
|
Facility
|
IP
|
$1,884.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
6158140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.33 |
| Max. Negotiated Rate |
$1,789.80 |
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cigna Commercial |
$1,601.40
|
| Rate for Payer: First Health Commercial |
$1,695.60
|
| Rate for Payer: First Health Workers Compensation |
$727.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,695.60
|
| Rate for Payer: GEHA Commercial |
$1,318.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,695.60
|
| Rate for Payer: Multiplan All |
$1,714.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,318.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,695.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,789.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,413.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,752.12
|
| Rate for Payer: Zelis Auto |
$753.60
|
| Rate for Payer: Zelis Worker's Compensation |
$514.33
|
|
|
MYOMECTOMY ABDOM METHOD
|
Facility
|
OP
|
$1,884.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
6158140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.00 |
| Max. Negotiated Rate |
$1,789.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cigna Commercial |
$1,601.40
|
| Rate for Payer: First Health Commercial |
$1,695.60
|
| Rate for Payer: First Health Workers Compensation |
$727.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,695.60
|
| Rate for Payer: GEHA Commercial |
$1,507.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,695.60
|
| Rate for Payer: Humana ChoiceCare |
$489.84
|
| Rate for Payer: Multiplan All |
$1,714.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,130.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,318.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,695.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,789.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,413.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,657.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$471.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,752.12
|
| Rate for Payer: Zelis Auto |
$753.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$942.00
|
| Rate for Payer: Zelis Worker's Compensation |
$514.33
|
|
|
MYOMECTOMY VAG METHOD
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
6158145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.12 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$668.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cigna Commercial |
$946.90
|
| Rate for Payer: First Health Commercial |
$1,002.60
|
| Rate for Payer: First Health Workers Compensation |
$430.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,002.60
|
| Rate for Payer: GEHA Commercial |
$891.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,002.60
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$1,013.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$779.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,002.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,058.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$835.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$445.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$304.12
|
|
|
MYOMECTOMY VAG METHOD
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
6158145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.12 |
| Max. Negotiated Rate |
$1,058.30 |
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cigna Commercial |
$946.90
|
| Rate for Payer: First Health Commercial |
$1,002.60
|
| Rate for Payer: First Health Workers Compensation |
$430.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,002.60
|
| Rate for Payer: GEHA Commercial |
$779.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,002.60
|
| Rate for Payer: Multiplan All |
$1,013.74
|
| Rate for Payer: OMNI Networks Commercial |
$779.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,002.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,058.30
|
| Rate for Payer: Three Rivers Provider Network All |
$835.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.02
|
| Rate for Payer: Zelis Auto |
$445.60
|
| Rate for Payer: Zelis Worker's Compensation |
$304.12
|
|
|
myotonic dystrophy 1 (dmpk) REF620084
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 81234
|
| Hospital Charge Code |
2200600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$162.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$156.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$137.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$150.70
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$230.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$166.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$137.00
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$232.90
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$191.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$166.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$137.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$274.00
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$134.26
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$137.00
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$116.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.89
|
|
|
myotonic dystrophy 1 (dmpk) REF620084
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 81234
|
| Hospital Charge Code |
2200600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$156.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$110.89
|
|
|
myotonic dystrophy2(znf9/cnbp) REF620087
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 81187
|
| Hospital Charge Code |
2200601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$156.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$110.89
|
|
|
myotonic dystrophy2(znf9/cnbp) REF620087
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 81187
|
| Hospital Charge Code |
2200601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$162.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$156.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$137.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$150.70
|
| Rate for Payer: Humana Medicare Advantage |
$137.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$230.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$166.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$137.00
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$232.90
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$191.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$166.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$137.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$274.00
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$134.26
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$137.00
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$116.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.89
|
|
|
myotonic dystrophy type 1 ref
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
2299559
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
myotonic dystrophy type 1 ref
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
2299559
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.59
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$29.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$16.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$18.25
|
| Rate for Payer: Humana Medicare Advantage |
$16.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.59
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.18
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.59
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$14.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.91
|
| Rate for Payer: Zelis Worker's Compensation |
$20.76
|
|
|
MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
6169420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
8300056
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$455.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
8300056
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
6169420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$455.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
NABUMETONE 750MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68462035901
|
| Hospital Charge Code |
3301810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
NABUMETONE 750MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68462035901
|
| Hospital Charge Code |
3301810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
NABUMETONE TAB 500MG
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 69097096507
|
| Hospital Charge Code |
3300628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
NABUMETONE TAB 500MG
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 69097096507
|
| Hospital Charge Code |
3300628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
NAFCILLIN 2GM VIAL
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
NDC 25021014010
|
| Hospital Charge Code |
3301128
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
NAFCILLIN 2GM VIAL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
NDC 25021014010
|
| Hospital Charge Code |
3301128
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
NAFCILLIN SODIUM FOR INJ 1GM
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
NDC 55150012215
|
| Hospital Charge Code |
3300629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$36.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$65.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Worker's Compensation |
$25.66
|
|
