|
ENDOSCOPY OF URETER
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 50951
|
| Hospital Charge Code |
6150951
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$217.31 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$676.60
|
| Rate for Payer: First Health Commercial |
$716.40
|
| Rate for Payer: First Health Workers Compensation |
$307.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$716.40
|
| Rate for Payer: GEHA Commercial |
$557.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$716.40
|
| Rate for Payer: Multiplan All |
$724.36
|
| Rate for Payer: OMNI Networks Commercial |
$557.20
|
| Rate for Payer: One Health Plan PPO/POS |
$716.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$756.20
|
| Rate for Payer: Three Rivers Provider Network All |
$597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$740.28
|
| Rate for Payer: Zelis Auto |
$318.40
|
| Rate for Payer: Zelis Worker's Compensation |
$217.31
|
|
|
ENDOSCOPY OF URETER
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
CPT 50953
|
| Hospital Charge Code |
6150953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$674.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
ENDOSCOPY OF URETER
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
CPT 50953
|
| Hospital Charge Code |
6150953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$800.85 |
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$590.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
ENDOSCOPY OF URETER
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 50951
|
| Hospital Charge Code |
6150951
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$217.31 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$477.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$676.60
|
| Rate for Payer: First Health Commercial |
$716.40
|
| Rate for Payer: First Health Workers Compensation |
$307.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$716.40
|
| Rate for Payer: GEHA Commercial |
$636.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$716.40
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$724.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$557.20
|
| Rate for Payer: One Health Plan PPO/POS |
$716.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$756.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$597.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$740.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$318.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$217.31
|
|
|
ENDOSTITCH
|
Facility
|
OP
|
$2,107.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.87 |
| Max. Negotiated Rate |
$2,002.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,264.48
|
| Rate for Payer: Cash Price |
$1,264.48
|
| Rate for Payer: Cash Price |
$1,264.48
|
| Rate for Payer: Cigna Commercial |
$1,791.35
|
| Rate for Payer: First Health Commercial |
$1,896.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,896.72
|
| Rate for Payer: GEHA Commercial |
$1,685.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,896.72
|
| Rate for Payer: Humana ChoiceCare |
$547.94
|
| Rate for Payer: Multiplan All |
$1,917.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,264.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,475.23
|
| Rate for Payer: One Health Plan PPO/POS |
$1,896.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,002.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,580.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.57
|
| Rate for Payer: United Healthcare Managed Medicaid |
$526.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,959.95
|
| Rate for Payer: Zelis Auto |
$842.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,053.73
|
|
|
ENDOSTITCH
|
Facility
|
IP
|
$2,107.47
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.99 |
| Max. Negotiated Rate |
$2,002.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,685.98
|
| Rate for Payer: Cash Price |
$1,264.48
|
| Rate for Payer: Cash Price |
$1,264.48
|
| Rate for Payer: Cigna Commercial |
$1,791.35
|
| Rate for Payer: First Health Commercial |
$1,896.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,896.72
|
| Rate for Payer: GEHA Commercial |
$1,475.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,896.72
|
| Rate for Payer: Multiplan All |
$1,917.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,475.23
|
| Rate for Payer: One Health Plan PPO/POS |
$1,896.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,002.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,580.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,959.95
|
| Rate for Payer: Zelis Auto |
$842.99
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
6191094
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$980.62 |
| Max. Negotiated Rate |
$3,412.40 |
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cigna Commercial |
$3,053.20
|
| Rate for Payer: First Health Commercial |
$3,232.80
|
| Rate for Payer: First Health Workers Compensation |
$1,386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,232.80
|
| Rate for Payer: GEHA Commercial |
$2,514.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,232.80
|
| Rate for Payer: Multiplan All |
$3,268.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,514.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,232.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,412.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,694.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,340.56
|
| Rate for Payer: Zelis Auto |
$1,436.80
|
| Rate for Payer: Zelis Worker's Compensation |
$980.62
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
6191094
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$980.62 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,539.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,539.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,803.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cigna Commercial |
$3,053.20
|
| Rate for Payer: First Health Commercial |
$3,232.80
|
| Rate for Payer: First Health Workers Compensation |
$1,386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,232.80
|
| Rate for Payer: GEHA Commercial |
$2,873.60
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,232.80
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,861.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$3,268.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,514.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,232.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,303.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,861.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,412.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$2,694.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,861.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,340.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$1,436.80
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$980.62
|
|
|
ENDOVENOUS MCHNCHEM ADD-ON
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
6191082
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
ENDOVENOUS MCHNCHEM ADD-ON
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
6191082
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
END TIDAL CO2 INIT
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
4000040
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$80.25 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$123.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$256.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Humana ChoiceCare |
$83.46
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$192.60
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$282.48
|
| Rate for Payer: United Healthcare Commercial |
$272.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$160.50
|
| Rate for Payer: Zelis Worker's Compensation |
$87.63
|
|
|
END TIDAL CO2 INIT
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
4000040
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$123.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$224.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Worker's Compensation |
$87.63
|
|
|
ENOXAPARIN SODIUM INJ 100MG/ML (SUBQ)
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
ENOXAPARIN SODIUM INJ 100MG/ML (SUBQ)
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$0.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
ENOXAPARIN SODIUM INJ 120MG/0.8ML (SUBQ)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3302949
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$40.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$0.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$27.30
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.00
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$92.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.50
|
| Rate for Payer: Zelis Worker's Compensation |
$28.66
|
|
|
ENOXAPARIN SODIUM INJ 120MG/0.8ML (SUBQ)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3302949
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$40.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$73.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.66
|
|
|
ENOXAPARIN SODIUM INJ 30MG/0.3ML (SUBQ)
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
ENOXAPARIN SODIUM INJ 30MG/0.3ML (SUBQ)
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$0.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$8.32
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.20
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
ENOXAPARIN SODIUM INJ 40MG/0.4ML (SUBQ)
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$0.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Humana ChoiceCare |
$11.44
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.40
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
ENOXAPARIN SODIUM INJ 40MG/0.4ML (SUBQ)
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$30.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
ENOXAPARIN SODIUM INJ 60MG/0.6ML (SUBQ)
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$0.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Humana ChoiceCare |
$17.42
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.20
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.50
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
ENOXAPARIN SODIUM INJ 60MG/0.6ML (SUBQ)
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$46.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
ENOXAPARIN SODIUM INJ 80MG/0.8ML (SUBQ)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$0.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$22.62
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.20
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$76.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.50
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
ENOXAPARIN SODIUM INJ 80MG/0.8ML (SUBQ)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
3300296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
ENTERECTOMY CONG, ADD-ON
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 44128
|
| Hospital Charge Code |
6144128
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$251.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$521.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Humana ChoiceCare |
$169.52
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$391.20
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$573.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$163.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$326.00
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
