|
IOHEXOL INJ 350MGI/ML 50ML
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3302860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
IO MAP OF SENT LYMPH NODE
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
6138900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$374.85
|
| Rate for Payer: First Health Commercial |
$396.90
|
| Rate for Payer: First Health Workers Compensation |
$170.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.90
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.90
|
| Rate for Payer: Humana ChoiceCare |
$114.66
|
| Rate for Payer: Multiplan All |
$401.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$264.60
|
| Rate for Payer: OMNI Networks Commercial |
$308.70
|
| Rate for Payer: One Health Plan PPO/POS |
$396.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.95
|
| Rate for Payer: Three Rivers Provider Network All |
$330.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$388.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.13
|
| Rate for Payer: Zelis Auto |
$176.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$220.50
|
| Rate for Payer: Zelis Worker's Compensation |
$120.39
|
|
|
IO MAP OF SENT LYMPH NODE
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
6138900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.39 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$374.85
|
| Rate for Payer: First Health Commercial |
$396.90
|
| Rate for Payer: First Health Workers Compensation |
$170.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.90
|
| Rate for Payer: GEHA Commercial |
$308.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.90
|
| Rate for Payer: Multiplan All |
$401.31
|
| Rate for Payer: OMNI Networks Commercial |
$308.70
|
| Rate for Payer: One Health Plan PPO/POS |
$396.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.95
|
| Rate for Payer: Three Rivers Provider Network All |
$330.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.13
|
| Rate for Payer: Zelis Auto |
$176.40
|
| Rate for Payer: Zelis Worker's Compensation |
$120.39
|
|
|
IOPAMIDOL 41% INJ
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
3300460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
IOPAMIDOL 41% INJ
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
3300460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$0.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$25.48
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.80
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.00
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
IOPAMIDOL IV SOLN 61%
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3300461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
IOPAMIDOL IV SOLN 61%
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3300461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
IOPAMIDOL IV SOLN 76% - 100mL
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3300462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$843.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Humana ChoiceCare |
$230.88
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.80
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$781.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.00
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
IOPAMIDOL IV SOLN 76% - 100mL
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
3300462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.42 |
| Max. Negotiated Rate |
$843.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
IP/OBS CONS NEW OR ESTAB, 35 MINS OR MOR
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
14099252
|
|
Hospital Revenue Code
|
988
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$72.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$72.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.23
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$153.60
|
| Rate for Payer: First Health Workers Compensation |
$125.28
|
| Rate for Payer: Health Net Federal Services Government |
$66.83
|
| Rate for Payer: HealthSmart Worker's Compensation |
$120.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$61.23
|
| Rate for Payer: Multiplan All |
$192.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$243.20
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$126.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.60
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$48.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$72.47
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$225.28
|
| Rate for Payer: Zelis Worker's Compensation |
$88.58
|
|
|
IP/OBS CONS NEW OR ESTAB, 45 MINS OR MOR
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
8199253
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
IP/OBS CONS NEW OR ESTAB, 45 MINS OR MOR
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
8199253
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$81.90
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$189.00
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$277.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.50
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
IPRATROPIUM 0.5MG / ALBUTEROL 2.5MG HHN
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
3300465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$0.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
IPRATROPIUM 0.5MG / ALBUTEROL 2.5MG HHN
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
3300465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
IPRATROPIUM-ALBUTEROL 20-100MCG
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
NDC 00597002402
|
| Hospital Charge Code |
3300464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$263.25 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$895.05
|
| Rate for Payer: First Health Commercial |
$947.70
|
| Rate for Payer: First Health Workers Compensation |
$406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$947.70
|
| Rate for Payer: GEHA Commercial |
$842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| Rate for Payer: Humana ChoiceCare |
$273.78
|
| Rate for Payer: Multiplan All |
$958.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$631.80
|
| Rate for Payer: OMNI Networks Commercial |
$737.10
|
| Rate for Payer: One Health Plan PPO/POS |
$947.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,000.35
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$926.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$979.29
|
| Rate for Payer: Zelis Auto |
$421.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$526.50
|
| Rate for Payer: Zelis Worker's Compensation |
$287.47
|
|
|
IPRATROPIUM-ALBUTEROL 20-100MCG
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
NDC 00597002402
|
| Hospital Charge Code |
3300464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$287.47 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$895.05
|
| Rate for Payer: First Health Commercial |
$947.70
|
| Rate for Payer: First Health Workers Compensation |
$406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$947.70
|
| Rate for Payer: GEHA Commercial |
$737.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| Rate for Payer: Multiplan All |
$958.23
|
| Rate for Payer: OMNI Networks Commercial |
$737.10
|
| Rate for Payer: One Health Plan PPO/POS |
$947.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,000.35
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$979.29
|
| Rate for Payer: Zelis Auto |
$421.20
|
| Rate for Payer: Zelis Worker's Compensation |
$287.47
|
|
|
IPRATROPIUM BROMIDE 0.02% HHN
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00487980101
|
| Hospital Charge Code |
3300463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
IPRATROPIUM BROMIDE 0.02% HHN
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00487980101
|
| Hospital Charge Code |
3300463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
IR ARTERIAL LINE INSERTION
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
7736620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$366.09 |
| Max. Negotiated Rate |
$1,273.95 |
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$1,139.85
|
| Rate for Payer: First Health Commercial |
$1,206.90
|
| Rate for Payer: First Health Workers Compensation |
$517.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,206.90
|
| Rate for Payer: GEHA Commercial |
$938.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,206.90
|
| Rate for Payer: Multiplan All |
$1,220.31
|
| Rate for Payer: OMNI Networks Commercial |
$938.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,206.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,273.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,005.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.13
|
| Rate for Payer: Zelis Auto |
$536.40
|
| Rate for Payer: Zelis Worker's Compensation |
$366.09
|
|
|
IR ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
7736620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.59 |
| Max. Negotiated Rate |
$1,273.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$804.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$1,139.85
|
| Rate for Payer: First Health Commercial |
$1,206.90
|
| Rate for Payer: First Health Workers Compensation |
$133.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,206.90
|
| Rate for Payer: GEHA Commercial |
$1,072.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,206.90
|
| Rate for Payer: Humana ChoiceCare |
$348.66
|
| Rate for Payer: Multiplan All |
$1,220.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$804.60
|
| Rate for Payer: OMNI Networks Commercial |
$938.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,206.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,273.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,005.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,180.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$335.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.13
|
| Rate for Payer: Zelis Auto |
$536.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$670.50
|
| Rate for Payer: Zelis Worker's Compensation |
$94.59
|
|
|
IR ARTHROCENT, INTRM JOINT; W/OUT US GUI
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
7720605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.10 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: First Health Workers Compensation |
$391.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Worker's Compensation |
$277.10
|
|
|
IR ARTHROCENT, INTRM JOINT; W/OUT US GUI
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
7720605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$609.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR ARTHROCENT, INTRM JOINT; W/US GUIDE
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
7720606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.49 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cigna Commercial |
$1,256.30
|
| Rate for Payer: First Health Commercial |
$1,330.20
|
| Rate for Payer: First Health Workers Compensation |
$570.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,330.20
|
| Rate for Payer: GEHA Commercial |
$1,034.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,330.20
|
| Rate for Payer: Multiplan All |
$1,344.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,034.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,330.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,404.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,108.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,374.54
|
| Rate for Payer: Zelis Auto |
$591.20
|
| Rate for Payer: Zelis Worker's Compensation |
$403.49
|
|
|
IR ARTHROCENT, INTRM JOINT; W/US GUIDE
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
7720606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$316.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$886.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$316.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$250.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cigna Commercial |
$1,256.30
|
| Rate for Payer: First Health Commercial |
$1,330.20
|
| Rate for Payer: First Health Workers Compensation |
$846.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,330.20
|
| Rate for Payer: GEHA Commercial |
$1,182.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,330.20
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$256.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$1,344.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,034.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,330.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$295.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$256.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,404.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,108.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,374.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$591.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
IR ARTHROCENT, MAJOR JOINT; W/US GUIDE
|
Facility
|
IP
|
$1,639.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
7720611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.45 |
| Max. Negotiated Rate |
$1,557.05 |
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$1,393.15
|
| Rate for Payer: First Health Commercial |
$1,475.10
|
| Rate for Payer: First Health Workers Compensation |
$632.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,475.10
|
| Rate for Payer: GEHA Commercial |
$1,147.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,475.10
|
| Rate for Payer: Multiplan All |
$1,491.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,147.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,475.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,557.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,524.27
|
| Rate for Payer: Zelis Auto |
$655.60
|
| Rate for Payer: Zelis Worker's Compensation |
$447.45
|
|
