|
PREP TUM CAV IORT PRTL MASS
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 19294
|
| Hospital Charge Code |
6169662
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
PREP TUM CAV IORT PRTL MASS
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 19294
|
| Hospital Charge Code |
6169662
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$617.50 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$642.20
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,482.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,173.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$617.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,235.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
PRESSURE TREATMENT ESOPHAGUS
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
6143460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$504.90
|
| Rate for Payer: Humana ChoiceCare |
$145.86
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$336.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$493.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: Zelis Auto |
$224.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$280.50
|
| Rate for Payer: Zelis Worker's Compensation |
$153.15
|
|
|
PRESSURE TREATMENT ESOPHAGUS
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
6143460
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
PRESUMPTIVE ID PATHOGENIC ORGAGANISMS SC
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2299059
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$143.20
|
| Rate for Payer: GEHA Medicare |
$6.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Humana ChoiceCare |
$7.29
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.63
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.27
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.26
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.50
|
| Rate for Payer: United Healthcare Commercial |
$152.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.63
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Medicare |
$5.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.96
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
PRESUMPTIVE ID PATHOGENIC ORGAGANISMS SC
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2299059
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: First Health Commercial |
$161.10
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$161.10
|
| Rate for Payer: GEHA Commercial |
$125.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$161.10
|
| Rate for Payer: Multiplan All |
$162.89
|
| Rate for Payer: OMNI Networks Commercial |
$125.30
|
| Rate for Payer: One Health Plan PPO/POS |
$161.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$170.05
|
| Rate for Payer: Three Rivers Provider Network All |
$134.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$166.47
|
| Rate for Payer: Zelis Auto |
$71.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
PREVNAR 13
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
3301122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$288.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.91
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$283.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Humana ChoiceCare |
$60.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$233.58
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$140.40
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$269.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$233.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$205.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.00
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
PREVNAR 13
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
3301122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEA
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
8193283
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: First Health Workers Compensation |
$181.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Commercial |
$398.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$128.04
|
|
|
PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEA
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
8193283
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: First Health Workers Compensation |
$181.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Worker's Compensation |
$128.04
|
|
|
PRIMIDONE 250MG TAB
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 00591532101
|
| Hospital Charge Code |
3300757
|
|
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
|
|
|
PRIMIDONE 250MG TAB
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 00591532101
|
| Hospital Charge Code |
3300757
|
|
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
|
|
|
PRIMIDONE 50 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
3303007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
PRIMIDONE 50 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
3303007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
primidone REF018713
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
2200301
|
|
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
|
|
|
primidone REF018713
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
2200301
|
|
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
|
|
|
PRLNGD IP/OB E/M SVC TIME EA ADDL 15 MIN
|
Facility
|
IP
|
$80.34
|
|
|
Service Code
|
CPT 99418
|
| Hospital Charge Code |
299419
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$76.32 |
| Rate for Payer: Cash Price |
$48.20
|
| Rate for Payer: Cigna Commercial |
$68.29
|
| Rate for Payer: First Health Commercial |
$72.31
|
| Rate for Payer: First Health Workers Compensation |
$31.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.31
|
| Rate for Payer: GEHA Commercial |
$56.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.31
|
| Rate for Payer: Multiplan All |
$73.11
|
| Rate for Payer: OMNI Networks Commercial |
$56.24
|
| Rate for Payer: One Health Plan PPO/POS |
$72.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.32
|
| Rate for Payer: Three Rivers Provider Network All |
$60.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.72
|
| Rate for Payer: Zelis Auto |
$32.14
|
| Rate for Payer: Zelis Worker's Compensation |
$21.93
|
|
|
PROBE BUTTON 10'' LG 2MM DBL END
|
Facility
|
OP
|
$393.00
|
|
| Hospital Charge Code |
90030937
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$102.18
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$235.80
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$345.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$196.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
PROBE BUTTON 10'' LG 2MM DBL END
|
Facility
|
IP
|
$393.00
|
|
| Hospital Charge Code |
90030937
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
PROBE BUTTONED D/ E 6.25 2MM 16CM.
|
Facility
|
OP
|
$393.00
|
|
| Hospital Charge Code |
90030936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$102.18
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$235.80
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$345.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$196.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
PROBE BUTTONED D/ E 6.25 2MM 16CM.
|
Facility
|
IP
|
$393.00
|
|
| Hospital Charge Code |
90030936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
PROBIOTIC CAPSULE
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 79854073540
|
| Hospital Charge Code |
3300759
|
|
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
|
|
|
PROBIOTIC CAPSULE
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 79854073540
|
| Hospital Charge Code |
3300759
|
|
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
|
|
|
probnp n terminal REF143000
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
2299756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$70.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$70.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$55.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: First Health Workers Compensation |
$46.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: GEHA Medicare |
$39.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$43.19
|
| Rate for Payer: Humana Medicare Advantage |
$39.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$65.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$39.26
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.74
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$65.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$39.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$78.52
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$285.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$39.26
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Medicare |
$33.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.11
|
| Rate for Payer: Zelis Worker's Compensation |
$32.78
|
|
|
probnp n terminal REF143000
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
2299756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: First Health Workers Compensation |
$46.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.78
|
|
