|
organism id, mold REF008474
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
22990364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$18.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.73
|
|
|
organism id, mold REF008474
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
22990364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$18.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.73
|
|
|
ORITAVANCIN 1200 MG INJ
|
Facility
|
IP
|
$2,881.00
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
3302954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$786.51 |
| Max. Negotiated Rate |
$2,736.95 |
| Rate for Payer: Cash Price |
$1,728.60
|
| Rate for Payer: Cigna Commercial |
$2,448.85
|
| Rate for Payer: First Health Commercial |
$2,592.90
|
| Rate for Payer: First Health Workers Compensation |
$1,112.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,592.90
|
| Rate for Payer: GEHA Commercial |
$2,016.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,592.90
|
| Rate for Payer: Multiplan All |
$2,621.71
|
| Rate for Payer: OMNI Networks Commercial |
$2,016.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,592.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,736.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,160.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,679.33
|
| Rate for Payer: Zelis Auto |
$1,152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$786.51
|
|
|
ORITAVANCIN 1200 MG INJ
|
Facility
|
OP
|
$2,881.00
|
|
|
Service Code
|
CPT J2407
|
| Hospital Charge Code |
3302954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$2,736.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,728.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.68
|
| Rate for Payer: Cash Price |
$1,728.60
|
| Rate for Payer: Cash Price |
$1,728.60
|
| Rate for Payer: Cigna Commercial |
$2,448.85
|
| Rate for Payer: First Health Commercial |
$2,592.90
|
| Rate for Payer: First Health Workers Compensation |
$1,112.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,592.90
|
| Rate for Payer: GEHA Commercial |
$31.55
|
| Rate for Payer: GEHA Medicare |
$28.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,592.90
|
| Rate for Payer: Humana ChoiceCare |
$31.55
|
| Rate for Payer: Humana Medicare Advantage |
$28.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$48.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.68
|
| Rate for Payer: Multiplan All |
$2,621.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,016.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,592.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,736.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$57.36
|
| Rate for Payer: Three Rivers Provider Network All |
$2,160.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,679.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.68
|
| Rate for Payer: Zelis Auto |
$1,152.40
|
| Rate for Payer: Zelis Medicare |
$24.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.42
|
| Rate for Payer: Zelis Worker's Compensation |
$786.51
|
|
|
ORTHO MRI JNT LOWER EXT
|
Facility
|
OP
|
$2,453.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
8800001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$2,330.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,471.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cigna Commercial |
$2,085.05
|
| Rate for Payer: First Health Commercial |
$2,207.70
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,207.70
|
| Rate for Payer: GEHA Commercial |
$1,962.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,207.70
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$2,232.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,717.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,207.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,330.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,839.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$2,085.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,281.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$981.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
ORTHO MRI JNT LOWER EXT
|
Facility
|
IP
|
$2,453.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
8800001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$2,330.35 |
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cigna Commercial |
$2,085.05
|
| Rate for Payer: First Health Commercial |
$2,207.70
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,207.70
|
| Rate for Payer: GEHA Commercial |
$1,717.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,207.70
|
| Rate for Payer: Multiplan All |
$2,232.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,717.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,207.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,330.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,839.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,281.29
|
| Rate for Payer: Zelis Auto |
$981.20
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
ORTHO MRI JNT UPPER EXT
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
8800004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$2,080.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,314.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,314.00
|
| Rate for Payer: Cash Price |
$1,314.00
|
| Rate for Payer: Cigna Commercial |
$1,861.50
|
| Rate for Payer: First Health Commercial |
$1,971.00
|
| Rate for Payer: First Health Workers Compensation |
$575.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,971.00
|
| Rate for Payer: GEHA Commercial |
$1,752.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,992.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,533.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,971.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,080.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,642.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,861.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,036.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$876.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
|
ORTHO MRI JNT UPPER EXT
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
8800004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$407.01 |
| Max. Negotiated Rate |
$2,080.50 |
| Rate for Payer: Cash Price |
$1,314.00
|
| Rate for Payer: Cash Price |
$1,314.00
|
| Rate for Payer: Cigna Commercial |
$1,861.50
|
| Rate for Payer: First Health Commercial |
$1,971.00
|
| Rate for Payer: First Health Workers Compensation |
$575.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,971.00
|
| Rate for Payer: GEHA Commercial |
$1,533.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.00
|
| Rate for Payer: Multiplan All |
$1,992.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,533.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,971.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,080.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,642.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,036.70
|
| Rate for Payer: Zelis Auto |
$876.00
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
|
ORTHO MRI JNT UPPER EXT W CONTRAST
|
Facility
|
OP
|
$2,453.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
8800000
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$2,330.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,471.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cigna Commercial |
$2,085.05
|
| Rate for Payer: First Health Commercial |
$2,207.70
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,207.70
|
| Rate for Payer: GEHA Commercial |
$1,962.40
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,207.70
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$2,232.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,717.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,207.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,330.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,839.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,085.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,281.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$981.20
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
ORTHO MRI JNT UPPER EXT W CONTRAST
|
Facility
|
OP
|
$2,453.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
8800003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$2,330.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,471.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cigna Commercial |
$2,085.05
|
| Rate for Payer: First Health Commercial |
$2,207.70
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,207.70
|
| Rate for Payer: GEHA Commercial |
$1,962.40
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,207.70
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$2,232.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,717.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,207.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,330.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,839.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,085.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,281.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$981.20
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
ORTHO MRI JNT UPPER EXT W CONTRAST
|
Facility
|
IP
|
$2,453.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
8800003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$2,330.35 |
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cigna Commercial |
$2,085.05
|
| Rate for Payer: First Health Commercial |
$2,207.70
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,207.70
|
| Rate for Payer: GEHA Commercial |
$1,717.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,207.70
|
| Rate for Payer: Multiplan All |
$2,232.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,717.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,207.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,330.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,839.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,281.29
|
| Rate for Payer: Zelis Auto |
$981.20
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
ORTHO MRI JNT UPPER EXT W CONTRAST
|
Facility
|
IP
|
$2,453.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
8800000
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$2,330.35 |
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cash Price |
$1,471.80
|
| Rate for Payer: Cigna Commercial |
$2,085.05
|
| Rate for Payer: First Health Commercial |
$2,207.70
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,207.70
|
| Rate for Payer: GEHA Commercial |
$1,717.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,207.70
|
| Rate for Payer: Multiplan All |
$2,232.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,717.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,207.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,330.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,839.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,281.29
|
| Rate for Payer: Zelis Auto |
$981.20
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
ORTHO MRI NO JNT LOWER EXT
|
Facility
|
IP
|
$2,486.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
8800002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.61 |
| Max. Negotiated Rate |
$2,361.70 |
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: Cigna Commercial |
$2,113.10
|
| Rate for Payer: First Health Commercial |
$2,237.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,237.40
|
| Rate for Payer: GEHA Commercial |
$1,740.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,237.40
|
| Rate for Payer: Multiplan All |
$2,262.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,740.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,237.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,361.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,864.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,311.98
|
| Rate for Payer: Zelis Auto |
$994.40
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
|
ORTHO MRI NO JNT LOWER EXT
|
Facility
|
OP
|
$2,486.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
8800002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$2,361.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,491.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: Cash Price |
$1,491.60
|
| Rate for Payer: Cigna Commercial |
$2,113.10
|
| Rate for Payer: First Health Commercial |
$2,237.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,237.40
|
| Rate for Payer: GEHA Commercial |
$1,988.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,237.40
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$2,262.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,740.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,237.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,361.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,864.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$2,113.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,311.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$994.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
|
ORTHO MRI NO JNT UPPER EXT
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
8800005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$1,833.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,158.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$1,640.50
|
| Rate for Payer: First Health Commercial |
$1,737.00
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.00
|
| Rate for Payer: GEHA Commercial |
$1,544.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,756.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,833.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,447.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,640.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,794.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$772.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
ORTHO MRI NO JNT UPPER EXT
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
8800005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$1,833.50 |
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$1,640.50
|
| Rate for Payer: First Health Commercial |
$1,737.00
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,737.00
|
| Rate for Payer: GEHA Commercial |
$1,351.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,737.00
|
| Rate for Payer: Multiplan All |
$1,756.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,351.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,737.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,833.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,447.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,794.90
|
| Rate for Payer: Zelis Auto |
$772.00
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
ORTHO XR SACRUM/COCCYX 2+ VIEW
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
8800006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$346.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
ORTHO XR SACRUM/COCCYX 2+ VIEW
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
8800006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$396.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$420.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
OSELTAMIVIR 30 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
NDC 47781038426
|
| Hospital Charge Code |
3302923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$36.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$11.96
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.60
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
OSELTAMIVIR 30 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
NDC 47781038426
|
| Hospital Charge Code |
3302923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$32.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
3302921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$32.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Humana ChoiceCare |
$10.40
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.00
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
3302921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
OSELTAMIVIR 45 MG CAPSULE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 68180067611
|
| Hospital Charge Code |
3302922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
OSELTAMIVIR 45 MG CAPSULE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 68180067611
|
| Hospital Charge Code |
3302922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
OSELTAMIVIR PHOSPHATE 75MG CAP
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
3300678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
