|
FUROSEMIDE 20MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3300368
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
FUROSEMIDE 40MG TAB
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3300369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
FUROSEMIDE 40MG TAB
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3300369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
FUROSEMIDE INJ 40MG/4ML
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
3300366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$4.68
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.80
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
FUROSEMIDE INJ 40MG/4ML
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT J1940
|
| Hospital Charge Code |
3300366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
FUROSEMIDE ORAL SOLN 10MG/ML
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60432061360
|
| Hospital Charge Code |
3300367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
FUROSEMIDE ORAL SOLN 10MG/ML
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 60432061360
|
| Hospital Charge Code |
3300367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
FUSE BILE DUCTS AND BOWEL
|
Facility
|
IP
|
$6,863.00
|
|
|
Service Code
|
CPT 47785
|
| Hospital Charge Code |
6147785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,873.60 |
| Max. Negotiated Rate |
$6,519.85 |
| Rate for Payer: Cash Price |
$4,117.80
|
| Rate for Payer: Cigna Commercial |
$5,833.55
|
| Rate for Payer: First Health Commercial |
$6,176.70
|
| Rate for Payer: First Health Workers Compensation |
$2,649.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,176.70
|
| Rate for Payer: GEHA Commercial |
$4,804.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,176.70
|
| Rate for Payer: Multiplan All |
$6,245.33
|
| Rate for Payer: OMNI Networks Commercial |
$4,804.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,176.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,519.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,147.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,382.59
|
| Rate for Payer: Zelis Auto |
$2,745.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,873.60
|
|
|
FUSE BILE DUCTS AND BOWEL
|
Facility
|
IP
|
$5,217.00
|
|
|
Service Code
|
CPT 47780
|
| Hospital Charge Code |
6147780
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,424.24 |
| Max. Negotiated Rate |
$4,956.15 |
| Rate for Payer: Cash Price |
$3,130.20
|
| Rate for Payer: Cigna Commercial |
$4,434.45
|
| Rate for Payer: First Health Commercial |
$4,695.30
|
| Rate for Payer: First Health Workers Compensation |
$2,014.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,695.30
|
| Rate for Payer: GEHA Commercial |
$3,651.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,695.30
|
| Rate for Payer: Multiplan All |
$4,747.47
|
| Rate for Payer: OMNI Networks Commercial |
$3,651.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,695.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,956.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,912.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,851.81
|
| Rate for Payer: Zelis Auto |
$2,086.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,424.24
|
|
|
FUSE BILE DUCTS AND BOWEL
|
Facility
|
OP
|
$6,863.00
|
|
|
Service Code
|
CPT 47785
|
| Hospital Charge Code |
6147785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,715.75 |
| Max. Negotiated Rate |
$6,519.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,117.80
|
| Rate for Payer: Cash Price |
$4,117.80
|
| Rate for Payer: Cigna Commercial |
$5,833.55
|
| Rate for Payer: First Health Commercial |
$6,176.70
|
| Rate for Payer: First Health Workers Compensation |
$2,649.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,176.70
|
| Rate for Payer: GEHA Commercial |
$5,490.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,176.70
|
| Rate for Payer: Humana ChoiceCare |
$1,784.38
|
| Rate for Payer: Multiplan All |
$6,245.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,117.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,804.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,176.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,519.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,147.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,039.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,715.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,382.59
|
| Rate for Payer: Zelis Auto |
$2,745.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,431.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,873.60
|
|
|
FUSE BILE DUCTS AND BOWEL
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
CPT 47760
|
| Hospital Charge Code |
6147760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,191.25 |
| Max. Negotiated Rate |
$4,526.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,859.00
|
| Rate for Payer: Cash Price |
$2,859.00
|
| Rate for Payer: Cigna Commercial |
$4,050.25
|
| Rate for Payer: First Health Commercial |
$4,288.50
|
| Rate for Payer: First Health Workers Compensation |
$1,839.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,288.50
|
| Rate for Payer: GEHA Commercial |
$3,812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,288.50
|
| Rate for Payer: Humana ChoiceCare |
$1,238.90
|
| Rate for Payer: Multiplan All |
$4,336.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,859.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,335.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,288.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,526.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,573.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,193.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,191.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,431.45
|
| Rate for Payer: Zelis Auto |
$1,906.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,382.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,300.85
|
|
|
FUSE BILE DUCTS AND BOWEL
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
CPT 47760
|
| Hospital Charge Code |
6147760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,300.85 |
| Max. Negotiated Rate |
$4,526.75 |
| Rate for Payer: Cash Price |
$2,859.00
|
| Rate for Payer: Cigna Commercial |
$4,050.25
|
| Rate for Payer: First Health Commercial |
$4,288.50
|
| Rate for Payer: First Health Workers Compensation |
$1,839.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,288.50
|
| Rate for Payer: GEHA Commercial |
$3,335.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,288.50
|
| Rate for Payer: Multiplan All |
$4,336.15
|
| Rate for Payer: OMNI Networks Commercial |
$3,335.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,288.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,526.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,573.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,431.45
|
| Rate for Payer: Zelis Auto |
$1,906.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,300.85
|
|
|
FUSE BILE DUCTS AND BOWEL
|
Facility
|
OP
|
$5,217.00
|
|
|
Service Code
|
CPT 47780
|
| Hospital Charge Code |
6147780
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,304.25 |
| Max. Negotiated Rate |
$4,956.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,130.20
|
| Rate for Payer: Cash Price |
$3,130.20
|
| Rate for Payer: Cigna Commercial |
$4,434.45
|
| Rate for Payer: First Health Commercial |
$4,695.30
|
| Rate for Payer: First Health Workers Compensation |
$2,014.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,695.30
|
| Rate for Payer: GEHA Commercial |
$4,173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,695.30
|
| Rate for Payer: Humana ChoiceCare |
$1,356.42
|
| Rate for Payer: Multiplan All |
$4,747.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,130.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,651.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,695.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,956.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,912.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,590.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,304.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,851.81
|
| Rate for Payer: Zelis Auto |
$2,086.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,608.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,424.24
|
|
|
FUSE ESOPHAGUS & INTESTINE
|
Facility
|
OP
|
$2,979.00
|
|
|
Service Code
|
CPT 43341
|
| Hospital Charge Code |
6143341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$744.75 |
| Max. Negotiated Rate |
$2,830.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,787.40
|
| Rate for Payer: Cash Price |
$1,787.40
|
| Rate for Payer: Cigna Commercial |
$2,532.15
|
| Rate for Payer: First Health Commercial |
$2,681.10
|
| Rate for Payer: First Health Workers Compensation |
$1,150.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,681.10
|
| Rate for Payer: GEHA Commercial |
$2,383.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,681.10
|
| Rate for Payer: Humana ChoiceCare |
$774.54
|
| Rate for Payer: Multiplan All |
$2,710.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,787.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,085.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,681.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,830.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,234.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,621.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,770.47
|
| Rate for Payer: Zelis Auto |
$1,191.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,489.50
|
| Rate for Payer: Zelis Worker's Compensation |
$813.27
|
|
|
FUSE ESOPHAGUS & INTESTINE
|
Facility
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 43340
|
| Hospital Charge Code |
6143340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$719.25 |
| Max. Negotiated Rate |
$2,733.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,726.20
|
| Rate for Payer: Cash Price |
$1,726.20
|
| Rate for Payer: Cigna Commercial |
$2,445.45
|
| Rate for Payer: First Health Commercial |
$2,589.30
|
| Rate for Payer: First Health Workers Compensation |
$1,110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,589.30
|
| Rate for Payer: GEHA Commercial |
$2,301.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,589.30
|
| Rate for Payer: Humana ChoiceCare |
$748.02
|
| Rate for Payer: Multiplan All |
$2,618.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,726.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,013.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,589.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,733.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,157.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,531.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$719.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,675.61
|
| Rate for Payer: Zelis Auto |
$1,150.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,438.50
|
| Rate for Payer: Zelis Worker's Compensation |
$785.42
|
|
|
FUSE ESOPHAGUS & INTESTINE
|
Facility
|
IP
|
$2,877.00
|
|
|
Service Code
|
CPT 43340
|
| Hospital Charge Code |
6143340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$785.42 |
| Max. Negotiated Rate |
$2,733.15 |
| Rate for Payer: Cash Price |
$1,726.20
|
| Rate for Payer: Cigna Commercial |
$2,445.45
|
| Rate for Payer: First Health Commercial |
$2,589.30
|
| Rate for Payer: First Health Workers Compensation |
$1,110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,589.30
|
| Rate for Payer: GEHA Commercial |
$2,013.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,589.30
|
| Rate for Payer: Multiplan All |
$2,618.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,013.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,589.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,733.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,157.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,675.61
|
| Rate for Payer: Zelis Auto |
$1,150.80
|
| Rate for Payer: Zelis Worker's Compensation |
$785.42
|
|
|
FUSE ESOPHAGUS & INTESTINE
|
Facility
|
IP
|
$2,979.00
|
|
|
Service Code
|
CPT 43341
|
| Hospital Charge Code |
6143341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$813.27 |
| Max. Negotiated Rate |
$2,830.05 |
| Rate for Payer: Cash Price |
$1,787.40
|
| Rate for Payer: Cigna Commercial |
$2,532.15
|
| Rate for Payer: First Health Commercial |
$2,681.10
|
| Rate for Payer: First Health Workers Compensation |
$1,150.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,681.10
|
| Rate for Payer: GEHA Commercial |
$2,085.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,681.10
|
| Rate for Payer: Multiplan All |
$2,710.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,085.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,681.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,830.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,234.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,770.47
|
| Rate for Payer: Zelis Auto |
$1,191.60
|
| Rate for Payer: Zelis Worker's Compensation |
$813.27
|
|
|
FUSE ESOPHAGUS & STOMACH
|
Facility
|
IP
|
$2,937.00
|
|
|
Service Code
|
CPT 43320
|
| Hospital Charge Code |
6143320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$801.80 |
| Max. Negotiated Rate |
$2,790.15 |
| Rate for Payer: Cash Price |
$1,762.20
|
| Rate for Payer: Cigna Commercial |
$2,496.45
|
| Rate for Payer: First Health Commercial |
$2,643.30
|
| Rate for Payer: First Health Workers Compensation |
$1,133.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,643.30
|
| Rate for Payer: GEHA Commercial |
$2,055.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,643.30
|
| Rate for Payer: Multiplan All |
$2,672.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,055.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,643.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,790.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,202.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,731.41
|
| Rate for Payer: Zelis Auto |
$1,174.80
|
| Rate for Payer: Zelis Worker's Compensation |
$801.80
|
|
|
FUSE ESOPHAGUS & STOMACH
|
Facility
|
OP
|
$2,937.00
|
|
|
Service Code
|
CPT 43320
|
| Hospital Charge Code |
6143320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$734.25 |
| Max. Negotiated Rate |
$2,790.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,762.20
|
| Rate for Payer: Cash Price |
$1,762.20
|
| Rate for Payer: Cigna Commercial |
$2,496.45
|
| Rate for Payer: First Health Commercial |
$2,643.30
|
| Rate for Payer: First Health Workers Compensation |
$1,133.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,643.30
|
| Rate for Payer: GEHA Commercial |
$2,349.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,643.30
|
| Rate for Payer: Humana ChoiceCare |
$763.62
|
| Rate for Payer: Multiplan All |
$2,672.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,762.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,055.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,643.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,790.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,202.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,584.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,731.41
|
| Rate for Payer: Zelis Auto |
$1,174.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,468.50
|
| Rate for Payer: Zelis Worker's Compensation |
$801.80
|
|
|
FUSE GALLBLADDER & BOWEL
|
Facility
|
IP
|
$2,733.00
|
|
|
Service Code
|
CPT 47740
|
| Hospital Charge Code |
6147740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$746.11 |
| Max. Negotiated Rate |
$2,596.35 |
| Rate for Payer: Cash Price |
$1,639.80
|
| Rate for Payer: Cigna Commercial |
$2,323.05
|
| Rate for Payer: First Health Commercial |
$2,459.70
|
| Rate for Payer: First Health Workers Compensation |
$1,055.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,459.70
|
| Rate for Payer: GEHA Commercial |
$1,913.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,459.70
|
| Rate for Payer: Multiplan All |
$2,487.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,913.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,459.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,596.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,049.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,541.69
|
| Rate for Payer: Zelis Auto |
$1,093.20
|
| Rate for Payer: Zelis Worker's Compensation |
$746.11
|
|
|
FUSE GALLBLADDER & BOWEL
|
Facility
|
IP
|
$2,414.00
|
|
|
Service Code
|
CPT 47720
|
| Hospital Charge Code |
6147720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$659.02 |
| Max. Negotiated Rate |
$2,293.30 |
| Rate for Payer: Cash Price |
$1,448.40
|
| Rate for Payer: Cigna Commercial |
$2,051.90
|
| Rate for Payer: First Health Commercial |
$2,172.60
|
| Rate for Payer: First Health Workers Compensation |
$932.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,172.60
|
| Rate for Payer: GEHA Commercial |
$1,689.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,172.60
|
| Rate for Payer: Multiplan All |
$2,196.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,689.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,172.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,293.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,810.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,245.02
|
| Rate for Payer: Zelis Auto |
$965.60
|
| Rate for Payer: Zelis Worker's Compensation |
$659.02
|
|
|
FUSE GALLBLADDER & BOWEL
|
Facility
|
OP
|
$2,414.00
|
|
|
Service Code
|
CPT 47720
|
| Hospital Charge Code |
6147720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.50 |
| Max. Negotiated Rate |
$2,293.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,448.40
|
| Rate for Payer: Cash Price |
$1,448.40
|
| Rate for Payer: Cigna Commercial |
$2,051.90
|
| Rate for Payer: First Health Commercial |
$2,172.60
|
| Rate for Payer: First Health Workers Compensation |
$932.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,172.60
|
| Rate for Payer: GEHA Commercial |
$1,931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,172.60
|
| Rate for Payer: Humana ChoiceCare |
$627.64
|
| Rate for Payer: Multiplan All |
$2,196.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,448.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,689.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,172.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,293.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,810.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,124.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$603.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,245.02
|
| Rate for Payer: Zelis Auto |
$965.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,207.00
|
| Rate for Payer: Zelis Worker's Compensation |
$659.02
|
|
|
FUSE GALLBLADDER & BOWEL
|
Facility
|
OP
|
$3,090.00
|
|
|
Service Code
|
CPT 47741
|
| Hospital Charge Code |
6147741
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$2,935.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,854.00
|
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Cigna Commercial |
$2,626.50
|
| Rate for Payer: First Health Commercial |
$2,781.00
|
| Rate for Payer: First Health Workers Compensation |
$1,193.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,781.00
|
| Rate for Payer: GEHA Commercial |
$2,472.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,781.00
|
| Rate for Payer: Humana ChoiceCare |
$803.40
|
| Rate for Payer: Multiplan All |
$2,811.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,854.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,163.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,781.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,935.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,317.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,719.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$772.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,873.70
|
| Rate for Payer: Zelis Auto |
$1,236.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,545.00
|
| Rate for Payer: Zelis Worker's Compensation |
$843.57
|
|
|
FUSE GALLBLADDER & BOWEL
|
Facility
|
IP
|
$3,090.00
|
|
|
Service Code
|
CPT 47741
|
| Hospital Charge Code |
6147741
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$843.57 |
| Max. Negotiated Rate |
$2,935.50 |
| Rate for Payer: Cash Price |
$1,854.00
|
| Rate for Payer: Cigna Commercial |
$2,626.50
|
| Rate for Payer: First Health Commercial |
$2,781.00
|
| Rate for Payer: First Health Workers Compensation |
$1,193.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,781.00
|
| Rate for Payer: GEHA Commercial |
$2,163.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,781.00
|
| Rate for Payer: Multiplan All |
$2,811.90
|
| Rate for Payer: OMNI Networks Commercial |
$2,163.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,781.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,935.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,317.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,873.70
|
| Rate for Payer: Zelis Auto |
$1,236.00
|
| Rate for Payer: Zelis Worker's Compensation |
$843.57
|
|
|
FUSE GALLBLADDER & BOWEL
|
Facility
|
OP
|
$2,733.00
|
|
|
Service Code
|
CPT 47740
|
| Hospital Charge Code |
6147740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$683.25 |
| Max. Negotiated Rate |
$2,596.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,639.80
|
| Rate for Payer: Cash Price |
$1,639.80
|
| Rate for Payer: Cigna Commercial |
$2,323.05
|
| Rate for Payer: First Health Commercial |
$2,459.70
|
| Rate for Payer: First Health Workers Compensation |
$1,055.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,459.70
|
| Rate for Payer: GEHA Commercial |
$2,186.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,459.70
|
| Rate for Payer: Humana ChoiceCare |
$710.58
|
| Rate for Payer: Multiplan All |
$2,487.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,639.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,913.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,459.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,596.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,049.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,405.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,541.69
|
| Rate for Payer: Zelis Auto |
$1,093.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,366.50
|
| Rate for Payer: Zelis Worker's Compensation |
$746.11
|
|
