|
NEG PRESSURE WOUND THER DME >50 SQ CM
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
20300128
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$59.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$122.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$41.77
|
|
|
NEG PRESSURE WOUND THER DME >50 SQ CM
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
1997606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$606.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
NEG PRESSURE WOUND THER DME >50 SQ CM
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
1997606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$692.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
NEG PRESSURE WOUND THER DME >50 SQ CM
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
20300128
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$59.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$107.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Worker's Compensation |
$41.77
|
|
|
NEG PRESSURE WOUND THER DME </= 50SCM
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
1997605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.15 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna Commercial |
$476.85
|
| Rate for Payer: First Health Commercial |
$504.90
|
| Rate for Payer: First Health Workers Compensation |
$216.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.90
|
| Rate for Payer: GEHA Commercial |
$392.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.90
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: OMNI Networks Commercial |
$392.70
|
| Rate for Payer: One Health Plan PPO/POS |
$504.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.95
|
| Rate for Payer: Three Rivers Provider Network All |
$420.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: Zelis Auto |
$224.40
|
| Rate for Payer: Zelis Worker's Compensation |
$153.15
|
|
|
NEG PRESSURE WOUND THER DME </= 50SCM
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
1997605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna Commercial |
$476.85
|
| Rate for Payer: First Health Commercial |
$504.90
|
| Rate for Payer: First Health Workers Compensation |
$216.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.90
|
| Rate for Payer: GEHA Commercial |
$448.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.90
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$392.70
|
| Rate for Payer: One Health Plan PPO/POS |
$504.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$420.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$224.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$153.15
|
|
|
NEG PRESSURE WOUND THER DME </= 50SCM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
20300127
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
NEG PRESSURE WOUND THER DME </= 50SCM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
20300127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$78.60
|
| 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 |
$104.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
NEG PRESSURE WOUND THER NON DME >50 SQCM
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
20300130
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$268.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$273.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$315.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$273.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
NEG PRESSURE WOUND THER NON DME >50 SQCM
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
20300130
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
NEG PRESSURE WOUND THER NON DME >50 SQCM
|
Facility
|
OP
|
$1,512.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
1997608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.02 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$907.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$268.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna Commercial |
$1,285.20
|
| Rate for Payer: First Health Commercial |
$1,360.80
|
| Rate for Payer: First Health Workers Compensation |
$583.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,360.80
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,360.80
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$273.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,375.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,058.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,360.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$315.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$273.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,436.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,406.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$604.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$412.78
|
|
|
NEG PRESSURE WOUND THER NON DME >50 SQCM
|
Facility
|
IP
|
$1,512.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
1997608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.78 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna Commercial |
$1,285.20
|
| Rate for Payer: First Health Commercial |
$1,360.80
|
| Rate for Payer: First Health Workers Compensation |
$583.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,360.80
|
| Rate for Payer: GEHA Commercial |
$1,058.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,360.80
|
| Rate for Payer: Multiplan All |
$1,375.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,058.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,360.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,436.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,406.16
|
| Rate for Payer: Zelis Auto |
$604.80
|
| Rate for Payer: Zelis Worker's Compensation |
$412.78
|
|
|
NEG PRESSURE WOUND THER NON DME 50 SQ CM
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
20300129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$51.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$93.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Worker's Compensation |
$36.31
|
|
|
NEG PRESSURE WOUND THER NON DME 50 SQ CM
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
20300129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$51.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$177.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$204.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$177.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$36.31
|
|
|
NEG PRESSURE WOUND THER NON DME 50 SQ CM
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
1997607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$572.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$810.90
|
| Rate for Payer: First Health Commercial |
$858.60
|
| Rate for Payer: First Health Workers Compensation |
$368.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$858.60
|
| Rate for Payer: GEHA Commercial |
$763.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$858.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$177.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$868.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$667.80
|
| Rate for Payer: One Health Plan PPO/POS |
$858.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$204.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$177.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$715.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$887.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$381.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$260.44
|
|
|
NEG PRESSURE WOUND THER NON DME 50 SQ CM
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
1997607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$810.90
|
| Rate for Payer: First Health Commercial |
$858.60
|
| Rate for Payer: First Health Workers Compensation |
$368.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$858.60
|
| Rate for Payer: GEHA Commercial |
$667.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$858.60
|
| Rate for Payer: Multiplan All |
$868.14
|
| Rate for Payer: OMNI Networks Commercial |
$667.80
|
| Rate for Payer: One Health Plan PPO/POS |
$858.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$906.30
|
| Rate for Payer: Three Rivers Provider Network All |
$715.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$887.22
|
| Rate for Payer: Zelis Auto |
$381.60
|
| Rate for Payer: Zelis Worker's Compensation |
$260.44
|
|
|
NEG PRESS WOUND THERAPY NON DME >50 SQCM
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
10097608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
NEOMYCIN-POLYMYXIN-HC OPTH SUSP
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
NDC 61314064175
|
| Hospital Charge Code |
3300638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.45 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
NEOMYCIN-POLYMYXIN-HC OPTH SUSP
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
NDC 61314064175
|
| Hospital Charge Code |
3300638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$169.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.00
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$572.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$325.00
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
NEOMYCIN SULFATE TAB 500MG
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 00093117701
|
| Hospital Charge Code |
3300635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
NEOMYCIN SULFATE TAB 500MG
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 00093117701
|
| Hospital Charge Code |
3300635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
NEOSTIGMINE 10 MG INJ MDV
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT J2710
|
| Hospital Charge Code |
3300640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: First Health Commercial |
$403.20
|
| Rate for Payer: First Health Workers Compensation |
$172.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.20
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.20
|
| Rate for Payer: Humana ChoiceCare |
$116.48
|
| Rate for Payer: Multiplan All |
$407.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$268.80
|
| Rate for Payer: OMNI Networks Commercial |
$313.60
|
| Rate for Payer: One Health Plan PPO/POS |
$403.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$425.60
|
| Rate for Payer: Three Rivers Provider Network All |
$336.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$394.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$112.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$416.64
|
| Rate for Payer: Zelis Auto |
$179.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$224.00
|
| Rate for Payer: Zelis Worker's Compensation |
$122.30
|
|
|
NEOSTIGMINE 10 MG INJ MDV
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT J2710
|
| Hospital Charge Code |
3300640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: First Health Commercial |
$403.20
|
| Rate for Payer: First Health Workers Compensation |
$172.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.20
|
| Rate for Payer: GEHA Commercial |
$313.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.20
|
| Rate for Payer: Multiplan All |
$407.68
|
| Rate for Payer: OMNI Networks Commercial |
$313.60
|
| Rate for Payer: One Health Plan PPO/POS |
$403.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$425.60
|
| Rate for Payer: Three Rivers Provider Network All |
$336.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$416.64
|
| Rate for Payer: Zelis Auto |
$179.20
|
| Rate for Payer: Zelis Worker's Compensation |
$122.30
|
|
|
NEPHELOMETRY NOT SPEC REF
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2300056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
|
NEPHELOMETRY NOT SPEC REF
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2300056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$17.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$14.96
|
| Rate for Payer: Humana Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.60
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.12
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.20
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.60
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$11.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.32
|
| Rate for Payer: Zelis Worker's Compensation |
$12.19
|
|
