|
VENTILATING TUBE RMVL REQUIRING GEN ANES
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
6169424
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: First Health Workers Compensation |
$72.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Worker's Compensation |
$51.60
|
|
|
VENTILATING TUBE RMVL REQUIRING GEN ANES
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
20300084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.47 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$227.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,504.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$322.15
|
| Rate for Payer: First Health Commercial |
$341.10
|
| Rate for Payer: First Health Workers Compensation |
$146.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$341.10
|
| Rate for Payer: GEHA Commercial |
$303.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$341.10
|
| 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 |
$1,535.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$344.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$265.30
|
| Rate for Payer: One Health Plan PPO/POS |
$341.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,772.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,535.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$360.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$284.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,535.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$352.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$151.60
|
| 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 |
$103.47
|
|
|
VENTILATING TUBE RMVL REQUIRING GEN ANES
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
6169424
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,899.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,504.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: First Health Workers Compensation |
$72.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| 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 |
$1,535.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,772.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,535.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,535.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$75.60
|
| 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 |
$51.60
|
|
|
VENTILATION ASSIST & MGMT I/P 1ST DAY
|
Facility
|
IP
|
$3,340.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4000620
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$911.82 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$2,839.00
|
| Rate for Payer: First Health Commercial |
$3,006.00
|
| Rate for Payer: First Health Workers Compensation |
$1,289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,006.00
|
| Rate for Payer: GEHA Commercial |
$2,338.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,006.00
|
| Rate for Payer: Multiplan All |
$3,039.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,338.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,006.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,173.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,505.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,106.20
|
| Rate for Payer: Zelis Auto |
$1,336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$911.82
|
|
|
VENTILATION ASSIST & MGMT I/P 1ST DAY
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4000620
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$293.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,004.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$293.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$232.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$627.74
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$2,839.00
|
| Rate for Payer: First Health Commercial |
$3,006.00
|
| Rate for Payer: First Health Workers Compensation |
$1,289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,006.00
|
| Rate for Payer: GEHA Commercial |
$2,672.00
|
| Rate for Payer: GEHA Medicare |
$627.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,006.00
|
| Rate for Payer: Humana ChoiceCare |
$690.51
|
| Rate for Payer: Humana Medicare Advantage |
$627.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,054.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$237.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$627.74
|
| Rate for Payer: Multiplan All |
$3,039.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,067.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,338.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,006.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$274.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$237.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$627.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,173.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,255.48
|
| Rate for Payer: Three Rivers Provider Network All |
$2,505.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$615.19
|
| Rate for Payer: United Healthcare Commercial |
$2,839.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$237.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$627.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,106.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$627.74
|
| Rate for Payer: Zelis Auto |
$1,336.00
|
| Rate for Payer: Zelis Medicare |
$533.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$753.29
|
| Rate for Payer: Zelis Worker's Compensation |
$911.82
|
|
|
VENTILATOR CIRCUIT
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
4000711
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$169.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.00
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$572.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$325.00
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
VENTILATOR CIRCUIT
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
4000711
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$177.45 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
VERAPAMIL 40 MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 23155005901
|
| Hospital Charge Code |
3302833
|
|
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
|
|
|
VERAPAMIL 40 MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 23155005901
|
| Hospital Charge Code |
3302833
|
|
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
|
|
|
VERAPAMIL CR 120MG TAB
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
3300940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
VERAPAMIL CR 120MG TAB
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
3300940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
VERAPAMIL ER 180 MG TABLET
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
3302837
|
|
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
|
|
|
VERAPAMIL ER 180 MG TABLET
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
3302837
|
|
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
|
|
|
VERAPAMIL HCL TAB 120MG
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00904292461
|
| Hospital Charge Code |
3300938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
VERAPAMIL HCL TAB 120MG
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00904292461
|
| Hospital Charge Code |
3300938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
VERAPAMIL HCL TAB 80MG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00904292061
|
| Hospital Charge Code |
3300939
|
|
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
|
|
|
VERAPAMIL HCL TAB 80MG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00904292061
|
| Hospital Charge Code |
3300939
|
|
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
|
|
|
VERAPAMIL HCL TAB CR 240MG
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 51079086920
|
| Hospital Charge Code |
3300941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
VERAPAMIL HCL TAB CR 240MG
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 51079086920
|
| Hospital Charge Code |
3300941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
VIAFLOW PLACENTAL TISSUE MATRIX-SAMPLE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
1909399
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
VIAFLOW PLACENTAL TISSUE MATRIX-SAMPLE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
1909399
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
VICTOZA 18MG/3ML PEN
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
NDC 00169406012
|
| Hospital Charge Code |
3300531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: First Health Workers Compensation |
$260.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Worker's Compensation |
$184.28
|
|
|
VICTOZA 18MG/3ML PEN
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
NDC 00169406012
|
| Hospital Charge Code |
3300531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: First Health Workers Compensation |
$260.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
| Rate for Payer: Zelis Worker's Compensation |
$184.28
|
|
|
vip plasma REF830401
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
2200841
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.14 |
| Max. Negotiated Rate |
$1,615.00 |
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,445.00
|
| Rate for Payer: First Health Commercial |
$1,530.00
|
| Rate for Payer: First Health Workers Compensation |
$55.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.00
|
| Rate for Payer: GEHA Commercial |
$1,190.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.00
|
| Rate for Payer: Multiplan All |
$1,547.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.00
|
| Rate for Payer: Zelis Auto |
$680.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.14
|
|
|
vip plasma REF830401
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
2200841
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$1,615.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,445.00
|
| Rate for Payer: First Health Commercial |
$1,530.00
|
| Rate for Payer: First Health Workers Compensation |
$55.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.00
|
| Rate for Payer: GEHA Commercial |
$1,360.00
|
| Rate for Payer: GEHA Medicare |
$35.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.00
|
| Rate for Payer: Humana ChoiceCare |
$38.86
|
| Rate for Payer: Humana Medicare Advantage |
$35.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.33
|
| Rate for Payer: Multiplan All |
$1,547.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$59.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.66
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.62
|
| Rate for Payer: United Healthcare Commercial |
$1,445.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.33
|
| Rate for Payer: Zelis Auto |
$680.00
|
| Rate for Payer: Zelis Medicare |
$30.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$39.14
|
|
