|
microsporidia stain REF828795
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
2200422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$12.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$6.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$7.35
|
| Rate for Payer: Humana Medicare Advantage |
$6.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.68
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.36
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.36
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.55
|
| Rate for Payer: United Healthcare Commercial |
$263.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.68
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$5.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.02
|
| Rate for Payer: Zelis Worker's Compensation |
$8.72
|
|
|
MICROSURGERY ADD-ON
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
6169990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$416.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
MICROSURGERY ADD-ON
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
6169990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Humana ChoiceCare |
$154.70
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$357.00
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$523.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$148.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$297.50
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
MIDAS REX 14CM 2MM BALL
|
Facility
|
OP
|
$1,072.00
|
|
| Hospital Charge Code |
90080109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$857.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Humana ChoiceCare |
$278.72
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$643.20
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$943.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$536.00
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
MIDAS REX 14CM 2MM BALL
|
Facility
|
IP
|
$1,072.00
|
|
| Hospital Charge Code |
90080109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.66 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
MIDAS REX 26CM 4MM BALL
|
Facility
|
IP
|
$1,182.00
|
|
| Hospital Charge Code |
90080107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$1,122.90 |
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$1,004.70
|
| Rate for Payer: First Health Commercial |
$1,063.80
|
| Rate for Payer: First Health Workers Compensation |
$456.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,063.80
|
| Rate for Payer: GEHA Commercial |
$827.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,063.80
|
| Rate for Payer: Multiplan All |
$1,075.62
|
| Rate for Payer: OMNI Networks Commercial |
$827.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,063.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,122.90
|
| Rate for Payer: Three Rivers Provider Network All |
$886.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,099.26
|
| Rate for Payer: Zelis Auto |
$472.80
|
| Rate for Payer: Zelis Worker's Compensation |
$322.69
|
|
|
MIDAS REX 26CM 4MM BALL
|
Facility
|
OP
|
$1,182.00
|
|
| Hospital Charge Code |
90080107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$1,122.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$1,004.70
|
| Rate for Payer: First Health Commercial |
$1,063.80
|
| Rate for Payer: First Health Workers Compensation |
$456.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,063.80
|
| Rate for Payer: GEHA Commercial |
$945.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,063.80
|
| Rate for Payer: Humana ChoiceCare |
$307.32
|
| Rate for Payer: Multiplan All |
$1,075.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$709.20
|
| Rate for Payer: OMNI Networks Commercial |
$827.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,063.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,122.90
|
| Rate for Payer: Three Rivers Provider Network All |
$886.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,040.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$295.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,099.26
|
| Rate for Payer: Zelis Auto |
$472.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$591.00
|
| Rate for Payer: Zelis Worker's Compensation |
$322.69
|
|
|
MIDAS REX 26CM 6MM BALL
|
Facility
|
OP
|
$1,171.00
|
|
| Hospital Charge Code |
90080106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.60
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$936.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Humana ChoiceCare |
$304.46
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$702.60
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,030.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$292.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$585.50
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
MIDAS REX 26CM 6MM BALL
|
Facility
|
IP
|
$1,171.00
|
|
| Hospital Charge Code |
90080106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$819.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
MIDAS REX 26CM 7.5MM CYL CUTTER
|
Facility
|
OP
|
$1,072.00
|
|
| Hospital Charge Code |
90080108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$857.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Humana ChoiceCare |
$278.72
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$643.20
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$943.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$536.00
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
MIDAS REX 26CM 7.5MM CYL CUTTER
|
Facility
|
IP
|
$1,072.00
|
|
| Hospital Charge Code |
90080108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.66 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
MIDAS REX 9CM 1.6MM CUTTER
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
90080110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.92 |
| Max. Negotiated Rate |
$1,287.25 |
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$1,151.75
|
| Rate for Payer: First Health Commercial |
$1,219.50
|
| Rate for Payer: First Health Workers Compensation |
$523.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,219.50
|
| Rate for Payer: GEHA Commercial |
$948.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,219.50
|
| Rate for Payer: Multiplan All |
$1,233.05
|
| Rate for Payer: OMNI Networks Commercial |
$948.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,219.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,287.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,016.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,260.15
|
| Rate for Payer: Zelis Auto |
$542.00
|
| Rate for Payer: Zelis Worker's Compensation |
$369.92
|
|
|
MIDAS REX 9CM 1.6MM CUTTER
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
90080110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$338.75 |
| Max. Negotiated Rate |
$1,287.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$813.00
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$1,151.75
|
| Rate for Payer: First Health Commercial |
$1,219.50
|
| Rate for Payer: First Health Workers Compensation |
$523.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,219.50
|
| Rate for Payer: GEHA Commercial |
$1,084.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,219.50
|
| Rate for Payer: Humana ChoiceCare |
$352.30
|
| Rate for Payer: Multiplan All |
$1,233.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$813.00
|
| Rate for Payer: OMNI Networks Commercial |
$948.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,219.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,287.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,016.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,192.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,260.15
|
| Rate for Payer: Zelis Auto |
$542.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$677.50
|
| Rate for Payer: Zelis Worker's Compensation |
$369.92
|
|
|
MIDAS REX 9CM 25.4MM CUTTER
|
Facility
|
OP
|
$1,171.00
|
|
| Hospital Charge Code |
90080112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.60
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$936.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Humana ChoiceCare |
$304.46
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$702.60
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,030.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$292.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$585.50
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
MIDAS REX 9CM 25.4MM CUTTER
|
Facility
|
IP
|
$1,171.00
|
|
| Hospital Charge Code |
90080112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$819.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
MIDAS REX 9CM 3MM METAL CUTTER
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
90080111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$338.75 |
| Max. Negotiated Rate |
$1,287.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$813.00
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$1,151.75
|
| Rate for Payer: First Health Commercial |
$1,219.50
|
| Rate for Payer: First Health Workers Compensation |
$523.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,219.50
|
| Rate for Payer: GEHA Commercial |
$1,084.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,219.50
|
| Rate for Payer: Humana ChoiceCare |
$352.30
|
| Rate for Payer: Multiplan All |
$1,233.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$813.00
|
| Rate for Payer: OMNI Networks Commercial |
$948.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,219.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,287.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,016.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,192.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,260.15
|
| Rate for Payer: Zelis Auto |
$542.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$677.50
|
| Rate for Payer: Zelis Worker's Compensation |
$369.92
|
|
|
MIDAS REX 9CM 3MM METAL CUTTER
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
90080111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.92 |
| Max. Negotiated Rate |
$1,287.25 |
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$1,151.75
|
| Rate for Payer: First Health Commercial |
$1,219.50
|
| Rate for Payer: First Health Workers Compensation |
$523.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,219.50
|
| Rate for Payer: GEHA Commercial |
$948.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,219.50
|
| Rate for Payer: Multiplan All |
$1,233.05
|
| Rate for Payer: OMNI Networks Commercial |
$948.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,219.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,287.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,016.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,260.15
|
| Rate for Payer: Zelis Auto |
$542.00
|
| Rate for Payer: Zelis Worker's Compensation |
$369.92
|
|
|
MIDAS REX TAPER 26CM 3MM
|
Facility
|
IP
|
$1,144.00
|
|
| Hospital Charge Code |
90080104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.31 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: First Health Workers Compensation |
$441.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
| Rate for Payer: Zelis Worker's Compensation |
$312.31
|
|
|
MIDAS REX TAPER 26CM 3MM
|
Facility
|
OP
|
$1,144.00
|
|
| Hospital Charge Code |
90080104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: First Health Workers Compensation |
$441.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$915.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Humana ChoiceCare |
$297.44
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$686.40
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,006.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$572.00
|
| Rate for Payer: Zelis Worker's Compensation |
$312.31
|
|
|
MIDAS REX TAPER 26CM 9MM BALL
|
Facility
|
IP
|
$1,134.00
|
|
| Hospital Charge Code |
90080105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$793.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
MIDAS REX TAPER 26CM 9MM BALL
|
Facility
|
OP
|
$1,134.00
|
|
| Hospital Charge Code |
90080105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Humana ChoiceCare |
$294.84
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$680.40
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$997.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$283.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$567.00
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
MIDAZOLAM 50MG/10 ML INJ
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
3302518
|
|
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
|
|
|
MIDAZOLAM 50MG/10 ML INJ
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
3302518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| 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: 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 |
$0.17
|
| 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
|
|
|
MIDAZOLAM 5MG/5ML VIAL - ANESTHESIA
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
3302005
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MIDAZOLAM 5MG/5ML VIAL - ANESTHESIA
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
3302005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| 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: 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 |
$0.17
|
| 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
|
|
