|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6136620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6136620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$41.60
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.00
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$140.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6100002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.59 |
| Max. Negotiated Rate |
$1,147.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$133.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$966.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| Rate for Payer: Humana ChoiceCare |
$314.08
|
| Rate for Payer: Multiplan All |
$1,099.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$724.80
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,147.60
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,063.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,123.44
|
| Rate for Payer: Zelis Auto |
$483.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.59
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
IP
|
$1,627.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
10036620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.17 |
| Max. Negotiated Rate |
$1,545.65 |
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cigna Commercial |
$1,382.95
|
| Rate for Payer: First Health Commercial |
$1,464.30
|
| Rate for Payer: First Health Workers Compensation |
$628.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,464.30
|
| Rate for Payer: GEHA Commercial |
$1,138.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,464.30
|
| Rate for Payer: Multiplan All |
$1,480.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,464.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,545.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,513.11
|
| Rate for Payer: Zelis Auto |
$650.80
|
| Rate for Payer: Zelis Worker's Compensation |
$444.17
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
8150110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$41.60
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.00
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$140.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
8150110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6100002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,147.60 |
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$466.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$845.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| Rate for Payer: Multiplan All |
$1,099.28
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,147.60
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,123.44
|
| Rate for Payer: Zelis Auto |
$483.20
|
| Rate for Payer: Zelis Worker's Compensation |
$329.78
|
|
|
ART LINE-CUT DOWN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 36625
|
| Hospital Charge Code |
3736625
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$90.36 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$231.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Worker's Compensation |
$90.36
|
|
|
ART LINE-CUT DOWN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 36625
|
| Hospital Charge Code |
3736625
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$264.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Humana ChoiceCare |
$86.06
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$198.60
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$291.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$165.50
|
| Rate for Payer: Zelis Worker's Compensation |
$90.36
|
|
|
AS-AORT GRF W/CARD BYP F/AORTIC DISSECTI
|
Facility
|
IP
|
$10,950.00
|
|
|
Service Code
|
CPT 33858
|
| Hospital Charge Code |
6133858
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,989.35 |
| Max. Negotiated Rate |
$10,402.50 |
| Rate for Payer: Cash Price |
$6,570.00
|
| Rate for Payer: Cigna Commercial |
$9,307.50
|
| Rate for Payer: First Health Commercial |
$9,855.00
|
| Rate for Payer: First Health Workers Compensation |
$4,227.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,855.00
|
| Rate for Payer: GEHA Commercial |
$7,665.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,855.00
|
| Rate for Payer: Multiplan All |
$9,964.50
|
| Rate for Payer: OMNI Networks Commercial |
$7,665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,855.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,402.50
|
| Rate for Payer: Three Rivers Provider Network All |
$8,212.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,183.50
|
| Rate for Payer: Zelis Auto |
$4,380.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,989.35
|
|
|
AS-AORT GRF W/CARD BYP F/AORTIC DISSECTI
|
Facility
|
OP
|
$10,950.00
|
|
|
Service Code
|
CPT 33858
|
| Hospital Charge Code |
6133858
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,737.50 |
| Max. Negotiated Rate |
$10,402.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,570.00
|
| Rate for Payer: Cash Price |
$6,570.00
|
| Rate for Payer: Cigna Commercial |
$9,307.50
|
| Rate for Payer: First Health Commercial |
$9,855.00
|
| Rate for Payer: First Health Workers Compensation |
$4,227.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,855.00
|
| Rate for Payer: GEHA Commercial |
$8,760.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,855.00
|
| Rate for Payer: Humana ChoiceCare |
$2,847.00
|
| Rate for Payer: Multiplan All |
$9,964.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,570.00
|
| Rate for Payer: OMNI Networks Commercial |
$7,665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,855.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,402.50
|
| Rate for Payer: Three Rivers Provider Network All |
$8,212.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,636.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,737.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,183.50
|
| Rate for Payer: Zelis Auto |
$4,380.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,475.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,989.35
|
|
|
AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/T
|
Facility
|
IP
|
$7,852.00
|
|
|
Service Code
|
CPT 33859
|
| Hospital Charge Code |
6133859
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,143.60 |
| Max. Negotiated Rate |
$7,459.40 |
| Rate for Payer: Cash Price |
$4,711.20
|
| Rate for Payer: Cigna Commercial |
$6,674.20
|
| Rate for Payer: First Health Commercial |
$7,066.80
|
| Rate for Payer: First Health Workers Compensation |
$3,031.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,066.80
|
| Rate for Payer: GEHA Commercial |
$5,496.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,066.80
|
| Rate for Payer: Multiplan All |
$7,145.32
|
| Rate for Payer: OMNI Networks Commercial |
$5,496.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,066.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,459.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,889.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,302.36
|
| Rate for Payer: Zelis Auto |
$3,140.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,143.60
|
|
|
AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/T
|
Facility
|
OP
|
$7,852.00
|
|
|
Service Code
|
CPT 33859
|
| Hospital Charge Code |
6133859
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,963.00 |
| Max. Negotiated Rate |
$7,459.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,711.20
|
| Rate for Payer: Cash Price |
$4,711.20
|
| Rate for Payer: Cigna Commercial |
$6,674.20
|
| Rate for Payer: First Health Commercial |
$7,066.80
|
| Rate for Payer: First Health Workers Compensation |
$3,031.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,066.80
|
| Rate for Payer: GEHA Commercial |
$6,281.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,066.80
|
| Rate for Payer: Humana ChoiceCare |
$2,041.52
|
| Rate for Payer: Multiplan All |
$7,145.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,711.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,496.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,066.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,459.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,889.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,909.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,963.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,302.36
|
| Rate for Payer: Zelis Auto |
$3,140.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,926.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,143.60
|
|
|
ascaris, IgE REF602923
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200814
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
ascaris, IgE REF602923
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200814
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
ASCENDING AORTIC GRAFT
|
Facility
|
OP
|
$6,712.00
|
|
|
Service Code
|
CPT 33863
|
| Hospital Charge Code |
6133863
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,678.00 |
| Max. Negotiated Rate |
$6,376.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,027.20
|
| Rate for Payer: Cash Price |
$4,027.20
|
| Rate for Payer: Cigna Commercial |
$5,705.20
|
| Rate for Payer: First Health Commercial |
$6,040.80
|
| Rate for Payer: First Health Workers Compensation |
$2,591.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,040.80
|
| Rate for Payer: GEHA Commercial |
$5,369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,040.80
|
| Rate for Payer: Humana ChoiceCare |
$1,745.12
|
| Rate for Payer: Multiplan All |
$6,107.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,027.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,698.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,040.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,376.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,034.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,906.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,678.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,242.16
|
| Rate for Payer: Zelis Auto |
$2,684.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,356.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,832.38
|
|
|
ASCENDING AORTIC GRAFT
|
Facility
|
IP
|
$6,712.00
|
|
|
Service Code
|
CPT 33863
|
| Hospital Charge Code |
6133863
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,832.38 |
| Max. Negotiated Rate |
$6,376.40 |
| Rate for Payer: Cash Price |
$4,027.20
|
| Rate for Payer: Cigna Commercial |
$5,705.20
|
| Rate for Payer: First Health Commercial |
$6,040.80
|
| Rate for Payer: First Health Workers Compensation |
$2,591.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,040.80
|
| Rate for Payer: GEHA Commercial |
$4,698.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,040.80
|
| Rate for Payer: Multiplan All |
$6,107.92
|
| Rate for Payer: OMNI Networks Commercial |
$4,698.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,040.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,376.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,034.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,242.16
|
| Rate for Payer: Zelis Auto |
$2,684.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,832.38
|
|
|
ASCORBIC ACID 500 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
3300069
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
ASCORBIC ACID 500 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
3300069
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
ASNIS 5.0 CANNULATED SCREW 5 X75
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
ASNIS 5.0 CANNULATED SCREW 5 X75
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
ASP BLADDER/SUPRAPUB
|
Facility
|
IP
|
$4,473.00
|
|
| Hospital Charge Code |
2407212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,221.13 |
| Max. Negotiated Rate |
$4,249.35 |
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cigna Commercial |
$3,802.05
|
| Rate for Payer: First Health Commercial |
$4,025.70
|
| Rate for Payer: First Health Workers Compensation |
$1,727.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,025.70
|
| Rate for Payer: GEHA Commercial |
$3,131.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,025.70
|
| Rate for Payer: Multiplan All |
$4,070.43
|
| Rate for Payer: OMNI Networks Commercial |
$3,131.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,025.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,249.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,354.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,159.89
|
| Rate for Payer: Zelis Auto |
$1,789.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,221.13
|
|
|
ASP BLADDER/SUPRAPUB
|
Facility
|
OP
|
$4,473.00
|
|
| Hospital Charge Code |
2407212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,118.25 |
| Max. Negotiated Rate |
$4,249.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,683.80
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cigna Commercial |
$3,802.05
|
| Rate for Payer: First Health Commercial |
$4,025.70
|
| Rate for Payer: First Health Workers Compensation |
$1,727.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,025.70
|
| Rate for Payer: GEHA Commercial |
$3,578.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,025.70
|
| Rate for Payer: Humana ChoiceCare |
$1,162.98
|
| Rate for Payer: Multiplan All |
$4,070.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,683.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,131.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,025.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,249.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,354.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,936.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,118.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,159.89
|
| Rate for Payer: Zelis Auto |
$1,789.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,236.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,221.13
|
|
|
ASPERCREME 10% CREAM
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 04116705724
|
| Hospital Charge Code |
3300927
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
ASPERCREME 10% CREAM
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 04116705724
|
| Hospital Charge Code |
3300927
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
