|
PUNCT ASPIRAT ABSCESS HEMATOMA BULLA/CYS
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
1910160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.93 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cigna Commercial |
$912.05
|
| Rate for Payer: First Health Commercial |
$965.70
|
| Rate for Payer: First Health Workers Compensation |
$414.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$965.70
|
| Rate for Payer: GEHA Commercial |
$751.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$965.70
|
| Rate for Payer: Multiplan All |
$976.43
|
| Rate for Payer: OMNI Networks Commercial |
$751.10
|
| Rate for Payer: One Health Plan PPO/POS |
$965.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,019.35
|
| Rate for Payer: Three Rivers Provider Network All |
$804.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$997.89
|
| Rate for Payer: Zelis Auto |
$429.20
|
| Rate for Payer: Zelis Worker's Compensation |
$292.93
|
|
|
PUNCTURE ASPIRATION ABSCESS HEMATOMA BUL
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
8510160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$1,004.15 |
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cigna Commercial |
$898.45
|
| Rate for Payer: First Health Commercial |
$951.30
|
| Rate for Payer: First Health Workers Compensation |
$408.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$951.30
|
| Rate for Payer: GEHA Commercial |
$739.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$951.30
|
| Rate for Payer: Multiplan All |
$961.87
|
| Rate for Payer: OMNI Networks Commercial |
$739.90
|
| Rate for Payer: One Health Plan PPO/POS |
$951.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,004.15
|
| Rate for Payer: Three Rivers Provider Network All |
$792.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$983.01
|
| Rate for Payer: Zelis Auto |
$422.80
|
| Rate for Payer: Zelis Worker's Compensation |
$288.56
|
|
|
PUNCTURE ASPIRATION ABSCESS HEMATOMA BUL
|
Facility
|
IP
|
$359.79
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7210160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$98.22 |
| Max. Negotiated Rate |
$341.80 |
| Rate for Payer: Cash Price |
$215.87
|
| Rate for Payer: Cigna Commercial |
$305.82
|
| Rate for Payer: First Health Commercial |
$323.81
|
| Rate for Payer: First Health Workers Compensation |
$138.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$323.81
|
| Rate for Payer: GEHA Commercial |
$251.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$323.81
|
| Rate for Payer: Multiplan All |
$327.41
|
| Rate for Payer: OMNI Networks Commercial |
$251.85
|
| Rate for Payer: One Health Plan PPO/POS |
$323.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$341.80
|
| Rate for Payer: Three Rivers Provider Network All |
$269.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$334.60
|
| Rate for Payer: Zelis Auto |
$143.92
|
| Rate for Payer: Zelis Worker's Compensation |
$98.22
|
|
|
PUNCTURE ASPIRATION ABSCESS HEMATOMA BUL
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
8510160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$1,004.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$634.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cigna Commercial |
$898.45
|
| Rate for Payer: First Health Commercial |
$951.30
|
| Rate for Payer: First Health Workers Compensation |
$408.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$951.30
|
| Rate for Payer: GEHA Commercial |
$845.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$951.30
|
| 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 |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$961.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$739.90
|
| Rate for Payer: One Health Plan PPO/POS |
$951.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,004.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$792.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$983.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$422.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$288.56
|
|
|
PUNCTURE ASPIRATION ABSCESS HEMATOMA BUL
|
Facility
|
OP
|
$359.79
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
7210160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$98.22 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$215.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$215.87
|
| Rate for Payer: Cash Price |
$215.87
|
| Rate for Payer: Cigna Commercial |
$305.82
|
| Rate for Payer: First Health Commercial |
$323.81
|
| Rate for Payer: First Health Workers Compensation |
$138.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$323.81
|
| Rate for Payer: GEHA Commercial |
$287.83
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$323.81
|
| 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 |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$327.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$251.85
|
| Rate for Payer: One Health Plan PPO/POS |
$323.81
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$341.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$269.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$334.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$143.92
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$98.22
|
|
|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
6119000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$53.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$97.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Worker's Compensation |
$37.95
|
|
|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
20300057
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$228.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
6119000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$83.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$53.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$111.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$37.95
|
|
|
PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
20300057
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$261.60
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
PUNCTURE/CLEAR WINDPIPE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
6131612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| 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 |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| 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 |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| 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 |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$41.77
|
|
|
PUNCTURE/CLEAR WINDPIPE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
6131612
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
PURAPLY 1 SQ CM
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT Q4195
|
| Hospital Charge Code |
1905281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.64
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$107.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Humana ChoiceCare |
$223.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.37
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$516.00
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$756.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
PURAPLY 1 SQ CM
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT Q4195
|
| Hospital Charge Code |
1905281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$602.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
PURAPLY AM 1 SQ CM
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT Q4196
|
| Hospital Charge Code |
1905282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$749.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$153.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$473.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$153.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$121.54
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cigna Commercial |
$670.65
|
| Rate for Payer: First Health Commercial |
$710.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$710.10
|
| Rate for Payer: GEHA Commercial |
$111.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$710.10
|
| Rate for Payer: Humana ChoiceCare |
$205.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.01
|
| Rate for Payer: Multiplan All |
$717.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$473.40
|
| Rate for Payer: OMNI Networks Commercial |
$552.30
|
| Rate for Payer: One Health Plan PPO/POS |
$710.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$143.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$749.55
|
| Rate for Payer: Three Rivers Provider Network All |
$591.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$694.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$733.77
|
| Rate for Payer: Zelis Auto |
$315.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$394.50
|
|
|
PURAPLY AM 1 SQ CM
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT Q4196
|
| Hospital Charge Code |
1905282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$749.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$631.20
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cigna Commercial |
$670.65
|
| Rate for Payer: First Health Commercial |
$710.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$710.10
|
| Rate for Payer: GEHA Commercial |
$552.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$710.10
|
| Rate for Payer: Multiplan All |
$717.99
|
| Rate for Payer: OMNI Networks Commercial |
$552.30
|
| Rate for Payer: One Health Plan PPO/POS |
$710.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$749.55
|
| Rate for Payer: Three Rivers Provider Network All |
$591.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$733.77
|
| Rate for Payer: Zelis Auto |
$315.60
|
|
|
PURAPLY XT 1 SQ CM
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT Q4197
|
| Hospital Charge Code |
1905283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.77 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$77.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Humana ChoiceCare |
$102.70
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$237.00
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$347.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$197.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
|
PURAPLY XT 1 SQ CM
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT Q4197
|
| Hospital Charge Code |
1905283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.83 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$276.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
|
PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
8592552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: First Health Workers Compensation |
$81.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$169.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$142.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$165.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$142.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$84.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$57.88
|
|
|
PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
8592552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: First Health Workers Compensation |
$81.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$148.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: Zelis Auto |
$84.80
|
| Rate for Payer: Zelis Worker's Compensation |
$57.88
|
|
|
PUTTY KNIFE BLADE
|
Facility
|
IP
|
$295.00
|
|
| Hospital Charge Code |
90002297
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.53 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: First Health Workers Compensation |
$113.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$206.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.53
|
|
|
PUTTY KNIFE BLADE
|
Facility
|
OP
|
$295.00
|
|
| Hospital Charge Code |
90002297
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: First Health Workers Compensation |
$113.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$236.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Humana ChoiceCare |
$76.70
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.00
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$259.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.50
|
| Rate for Payer: Zelis Worker's Compensation |
$80.53
|
|
|
PYRAZINAMIDE 500 MG TAB
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
3302889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
PYRAZINAMIDE 500 MG TAB
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
3302889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$15.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
PYRIDOSTIGMINE 60 MG TAB
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
3303060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
PYRIDOSTIGMINE 60 MG TAB
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00904662261
|
| Hospital Charge Code |
3303060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
