|
ENTERECTOMY CONG, ADD-ON
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 44128
|
| Hospital Charge Code |
6144128
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$619.40 |
| 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 |
$456.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Multiplan All |
$593.32
|
| 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: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
|
ENTERECTOMY W/O TAPER, CONG
|
Facility
|
OP
|
$5,211.00
|
|
|
Service Code
|
CPT 44126
|
| Hospital Charge Code |
6144126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,302.75 |
| Max. Negotiated Rate |
$4,950.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,126.60
|
| Rate for Payer: Cash Price |
$3,126.60
|
| Rate for Payer: Cigna Commercial |
$4,429.35
|
| Rate for Payer: First Health Commercial |
$4,689.90
|
| Rate for Payer: First Health Workers Compensation |
$2,011.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,689.90
|
| Rate for Payer: GEHA Commercial |
$4,168.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,689.90
|
| Rate for Payer: Humana ChoiceCare |
$1,354.86
|
| Rate for Payer: Multiplan All |
$4,742.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,126.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,647.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,689.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,950.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,908.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,585.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,302.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,846.23
|
| Rate for Payer: Zelis Auto |
$2,084.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,605.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,422.60
|
|
|
ENTERECTOMY W/O TAPER, CONG
|
Facility
|
IP
|
$5,211.00
|
|
|
Service Code
|
CPT 44126
|
| Hospital Charge Code |
6144126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,422.60 |
| Max. Negotiated Rate |
$4,950.45 |
| Rate for Payer: Cash Price |
$3,126.60
|
| Rate for Payer: Cigna Commercial |
$4,429.35
|
| Rate for Payer: First Health Commercial |
$4,689.90
|
| Rate for Payer: First Health Workers Compensation |
$2,011.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,689.90
|
| Rate for Payer: GEHA Commercial |
$3,647.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,689.90
|
| Rate for Payer: Multiplan All |
$4,742.01
|
| Rate for Payer: OMNI Networks Commercial |
$3,647.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,689.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,950.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,908.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,846.23
|
| Rate for Payer: Zelis Auto |
$2,084.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,422.60
|
|
|
ENTERECTOMY W/TAPER, CONG
|
Facility
|
OP
|
$5,981.00
|
|
|
Service Code
|
CPT 44127
|
| Hospital Charge Code |
6144127
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,495.25 |
| Max. Negotiated Rate |
$5,681.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,588.60
|
| Rate for Payer: Cash Price |
$3,588.60
|
| Rate for Payer: Cigna Commercial |
$5,083.85
|
| Rate for Payer: First Health Commercial |
$5,382.90
|
| Rate for Payer: First Health Workers Compensation |
$2,309.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,382.90
|
| Rate for Payer: GEHA Commercial |
$4,784.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,382.90
|
| Rate for Payer: Humana ChoiceCare |
$1,555.06
|
| Rate for Payer: Multiplan All |
$5,442.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,588.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,186.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,382.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,681.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,485.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,263.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,495.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,562.33
|
| Rate for Payer: Zelis Auto |
$2,392.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,990.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,632.81
|
|
|
ENTERECTOMY W/TAPER, CONG
|
Facility
|
IP
|
$5,981.00
|
|
|
Service Code
|
CPT 44127
|
| Hospital Charge Code |
6144127
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,632.81 |
| Max. Negotiated Rate |
$5,681.95 |
| Rate for Payer: Cash Price |
$3,588.60
|
| Rate for Payer: Cigna Commercial |
$5,083.85
|
| Rate for Payer: First Health Commercial |
$5,382.90
|
| Rate for Payer: First Health Workers Compensation |
$2,309.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,382.90
|
| Rate for Payer: GEHA Commercial |
$4,186.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,382.90
|
| Rate for Payer: Multiplan All |
$5,442.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,186.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,382.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,681.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,485.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,562.33
|
| Rate for Payer: Zelis Auto |
$2,392.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,632.81
|
|
|
enterovirus real time pcr REF834010
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
2299275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$54.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$277.60
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$294.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$38.19
|
|
|
enterovirus real time pcr REF834010
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
2299275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$54.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$242.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.19
|
|
|
ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC P
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 90882
|
| Hospital Charge Code |
8499245
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$65.52
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.20
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$221.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC P
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 90882
|
| Hospital Charge Code |
8499245
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC P
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 90882
|
| Hospital Charge Code |
9599247
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$65.52
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.20
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$221.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC P
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 90882
|
| Hospital Charge Code |
9599247
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
eosinophil urine REF115055
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
2299830
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$46.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$31.20
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.00
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.76
|
|
|
eosinophil urine REF115055
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
2299830
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$46.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.76
|
|
|
ePHEDrine 25MG/5ML SYR. - ANESTHESIA
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
NDC 69374090105
|
| Hospital Charge Code |
3305006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$234.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$76.18
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.80
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.50
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
ePHEDrine 25MG/5ML SYR. - ANESTHESIA
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
NDC 69374090105
|
| Hospital Charge Code |
3305006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$205.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
EPHEDrine SULFATE INJ 50 MG/10 ML VIAL
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
NDC 14789025010
|
| Hospital Charge Code |
3302958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$80.60
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$186.00
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$272.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$77.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$155.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
EPHEDrine SULFATE INJ 50 MG/10 ML VIAL
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
NDC 14789025010
|
| Hospital Charge Code |
3302958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
ePHEDrine SULFATE INJ 50MG/ML
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 70121163707
|
| Hospital Charge Code |
3300297
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: First Health Workers Compensation |
$110.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$199.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.81
|
|
|
ePHEDrine SULFATE INJ 50MG/ML
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 70121163707
|
| Hospital Charge Code |
3300297
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: First Health Workers Compensation |
$110.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.00
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$250.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.50
|
| Rate for Payer: Zelis Worker's Compensation |
$77.81
|
|
|
EPIDERMAL AGRFT FSNHFGMD GT 1ST 100 CM/<
|
Facility
|
OP
|
$4,136.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
1999256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$3,929.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,481.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cigna Commercial |
$3,515.60
|
| Rate for Payer: First Health Commercial |
$3,722.40
|
| Rate for Payer: First Health Workers Compensation |
$1,596.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,722.40
|
| Rate for Payer: GEHA Commercial |
$3,308.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,722.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$3,763.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,895.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,722.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,929.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$3,102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,846.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,654.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,129.13
|
|
|
EPIDERMAL AGRFT FSNHFGMD GT 1ST 100 CM/<
|
Facility
|
OP
|
$1,471.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
6115115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$882.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$882.60
|
| Rate for Payer: Cash Price |
$882.60
|
| Rate for Payer: Cigna Commercial |
$1,250.35
|
| Rate for Payer: First Health Commercial |
$1,323.90
|
| Rate for Payer: First Health Workers Compensation |
$567.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.90
|
| Rate for Payer: GEHA Commercial |
$1,176.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.90
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,338.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,397.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,103.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$588.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$401.58
|
|
|
EPIDERMAL AGRFT FSNHFGMD GT 1ST 100 CM/<
|
Facility
|
IP
|
$4,136.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
1999256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,129.13 |
| Max. Negotiated Rate |
$3,929.20 |
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cigna Commercial |
$3,515.60
|
| Rate for Payer: First Health Commercial |
$3,722.40
|
| Rate for Payer: First Health Workers Compensation |
$1,596.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,722.40
|
| Rate for Payer: GEHA Commercial |
$2,895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,722.40
|
| Rate for Payer: Multiplan All |
$3,763.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,895.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,722.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,929.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,846.48
|
| Rate for Payer: Zelis Auto |
$1,654.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,129.13
|
|
|
EPIDERMAL AGRFT FSNHFGMD GT 1ST 100 CM/<
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
6115115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.58 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Cash Price |
$882.60
|
| Rate for Payer: Cigna Commercial |
$1,250.35
|
| Rate for Payer: First Health Commercial |
$1,323.90
|
| Rate for Payer: First Health Workers Compensation |
$567.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.90
|
| Rate for Payer: GEHA Commercial |
$1,029.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.90
|
| Rate for Payer: Multiplan All |
$1,338.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,397.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,103.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.03
|
| Rate for Payer: Zelis Auto |
$588.40
|
| Rate for Payer: Zelis Worker's Compensation |
$401.58
|
|
|
EPIDRM AGRFT F/S/N/H/F/G/M/D GT EA 100CM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 15116
|
| Hospital Charge Code |
6115116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.03 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Worker's Compensation |
$119.03
|
|
|
EPIDRM AGRFT F/S/N/H/F/G/M/D GT EA 100CM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 15116
|
| Hospital Charge Code |
6115116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$448.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
| Rate for Payer: Zelis Worker's Compensation |
$119.03
|
|
