|
AMBULATORY BP MONITORING
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 93784
|
| Hospital Charge Code |
9000015
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$57.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$103.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
AMBULATORY BP RECORDING
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 93786
|
| Hospital Charge Code |
9000016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
AMBULATORY BP RECORDING
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 93786
|
| Hospital Charge Code |
9000016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
amebiasis abs (e. histolytica) REF006874
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2299730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$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 |
$19.44
|
| 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 |
$13.75
|
|
|
amebiasis abs (e. histolytica) REF006874
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2299730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$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 |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$12.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$13.63
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.39
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.06
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.78
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.39
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$10.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.87
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
|
AMERIGEL 28GM TUBE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
NDC 61470101401
|
| Hospital Charge Code |
3300950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$109.65
|
| Rate for Payer: First Health Commercial |
$116.10
|
| Rate for Payer: First Health Workers Compensation |
$49.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$116.10
|
| Rate for Payer: GEHA Commercial |
$90.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$116.10
|
| Rate for Payer: Multiplan All |
$117.39
|
| Rate for Payer: OMNI Networks Commercial |
$90.30
|
| Rate for Payer: One Health Plan PPO/POS |
$116.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$122.55
|
| Rate for Payer: Three Rivers Provider Network All |
$96.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.97
|
| Rate for Payer: Zelis Auto |
$51.60
|
| Rate for Payer: Zelis Worker's Compensation |
$35.22
|
|
|
AMERIGEL 28GM TUBE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
NDC 61470101401
|
| Hospital Charge Code |
3300950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$109.65
|
| Rate for Payer: First Health Commercial |
$116.10
|
| Rate for Payer: First Health Workers Compensation |
$49.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$116.10
|
| Rate for Payer: GEHA Commercial |
$103.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$116.10
|
| Rate for Payer: Humana ChoiceCare |
$33.54
|
| Rate for Payer: Multiplan All |
$117.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$77.40
|
| Rate for Payer: OMNI Networks Commercial |
$90.30
|
| Rate for Payer: One Health Plan PPO/POS |
$116.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$122.55
|
| Rate for Payer: Three Rivers Provider Network All |
$96.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$113.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.97
|
| Rate for Payer: Zelis Auto |
$51.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$64.50
|
| Rate for Payer: Zelis Worker's Compensation |
$35.22
|
|
|
AMIKACIN 750MG/NS 250ML IVPB
|
Facility
|
IP
|
$34.40
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
3303262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$32.68 |
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cigna Commercial |
$29.24
|
| Rate for Payer: First Health Commercial |
$30.96
|
| Rate for Payer: First Health Workers Compensation |
$13.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.96
|
| Rate for Payer: GEHA Commercial |
$24.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.96
|
| Rate for Payer: Multiplan All |
$31.30
|
| Rate for Payer: OMNI Networks Commercial |
$24.08
|
| Rate for Payer: One Health Plan PPO/POS |
$30.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.68
|
| Rate for Payer: Three Rivers Provider Network All |
$25.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.99
|
| Rate for Payer: Zelis Auto |
$13.76
|
| Rate for Payer: Zelis Worker's Compensation |
$9.39
|
|
|
AMIKACIN 750MG/NS 250ML IVPB
|
Facility
|
OP
|
$34.40
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
3303262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$32.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.64
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Cigna Commercial |
$29.24
|
| Rate for Payer: First Health Commercial |
$30.96
|
| Rate for Payer: First Health Workers Compensation |
$13.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.96
|
| Rate for Payer: GEHA Commercial |
$0.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.96
|
| Rate for Payer: Humana ChoiceCare |
$8.94
|
| Rate for Payer: Multiplan All |
$31.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.64
|
| Rate for Payer: OMNI Networks Commercial |
$24.08
|
| Rate for Payer: One Health Plan PPO/POS |
$30.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.68
|
| Rate for Payer: Three Rivers Provider Network All |
$25.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.99
|
| Rate for Payer: Zelis Auto |
$13.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.20
|
| Rate for Payer: Zelis Worker's Compensation |
$9.39
|
|
|
amikacin peak REF007204
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
2200623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
amikacin peak REF007204
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
2200623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$15.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$16.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.08
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.64
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.16
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$168.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.08
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$12.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.10
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
AMIKACIN SULFATE INJ 500 MG/ 2 ML
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
3302917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
AMIKACIN SULFATE INJ 500 MG/ 2 ML
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
3302917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$0.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$24.18
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.80
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
amikacin trough REF007205
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
2200616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
amikacin trough REF007205
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
2200616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$15.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$16.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.08
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.64
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.16
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$168.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.08
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$12.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.10
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
amino acid prof, quant plasma REF700068
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
2299315
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$29.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: GEHA Medicare |
$16.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Humana ChoiceCare |
$18.56
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.87
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.68
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.74
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$357.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.87
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Medicare |
$14.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.24
|
| Rate for Payer: Zelis Worker's Compensation |
$20.92
|
|
|
amino acid prof, quant plasma REF700068
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
2299315
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$29.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$294.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Worker's Compensation |
$20.92
|
|
|
AMINOCAPROIC ACID 5 GM/20 ML INJ VIAL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
AMINOCAPROIC ACID 5 GM/20 ML INJ VIAL
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
AMINOPHYLLINE 250 MG/10 ML SD INJ
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
3303038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
AMINOPHYLLINE 250 MG/10 ML SD INJ
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
3303038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$11.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
AMINOPHYLLINE 500MG/20ML VIAL FOR IVPB
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
3300037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
AMINOPHYLLINE 500MG/20ML VIAL FOR IVPB
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
3300037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$11.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
AMIODARONE 150MG/100ML D5W PREMIX
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT J0282
|
| Hospital Charge Code |
3300038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
AMIODARONE 150MG/100ML D5W PREMIX
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT J0282
|
| Hospital Charge Code |
3300038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$0.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$70.72
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$163.20
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$239.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$136.00
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
