|
PALINGEN FLOW
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT Q4174
|
| Hospital Charge Code |
7009040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,845.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,060.00
|
| Rate for Payer: Cash Price |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$4,335.00
|
| Rate for Payer: First Health Commercial |
$4,590.00
|
| Rate for Payer: First Health Workers Compensation |
$1,969.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,590.00
|
| Rate for Payer: GEHA Commercial |
$4,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,590.00
|
| Rate for Payer: Humana ChoiceCare |
$1,326.00
|
| Rate for Payer: Multiplan All |
$4,641.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,060.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,570.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,590.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,845.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,825.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,488.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,275.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,743.00
|
| Rate for Payer: Zelis Auto |
$2,040.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,550.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,392.30
|
|
|
PALINGEN FLOW
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
CPT Q4174
|
| Hospital Charge Code |
7009040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,392.30 |
| Max. Negotiated Rate |
$4,845.00 |
| Rate for Payer: Cash Price |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$4,335.00
|
| Rate for Payer: First Health Commercial |
$4,590.00
|
| Rate for Payer: First Health Workers Compensation |
$1,969.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,590.00
|
| Rate for Payer: GEHA Commercial |
$3,570.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,590.00
|
| Rate for Payer: Multiplan All |
$4,641.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,570.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,590.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,845.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,825.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,743.00
|
| Rate for Payer: Zelis Auto |
$2,040.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,392.30
|
|
|
PALINGEN MEMBRAIN 1X1
|
Facility
|
OP
|
$3,161.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
7009039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$3,002.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,896.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.22
|
| Rate for Payer: Cash Price |
$1,896.60
|
| Rate for Payer: Cash Price |
$1,896.60
|
| Rate for Payer: Cash Price |
$1,896.60
|
| Rate for Payer: Cigna Commercial |
$2,686.85
|
| Rate for Payer: First Health Commercial |
$2,844.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,844.90
|
| Rate for Payer: GEHA Commercial |
$33.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,844.90
|
| Rate for Payer: Humana ChoiceCare |
$821.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.96
|
| Rate for Payer: Multiplan All |
$2,876.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,896.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,212.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,844.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,002.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,370.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,781.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,939.73
|
| Rate for Payer: Zelis Auto |
$1,264.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,580.50
|
|
|
PALINGEN MEMBRAIN 1X1
|
Facility
|
IP
|
$3,161.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
7009039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.40 |
| Max. Negotiated Rate |
$3,002.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,528.80
|
| Rate for Payer: Cash Price |
$1,896.60
|
| Rate for Payer: Cash Price |
$1,896.60
|
| Rate for Payer: Cigna Commercial |
$2,686.85
|
| Rate for Payer: First Health Commercial |
$2,844.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,844.90
|
| Rate for Payer: GEHA Commercial |
$2,212.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,844.90
|
| Rate for Payer: Multiplan All |
$2,876.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,212.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,844.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,002.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,370.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,939.73
|
| Rate for Payer: Zelis Auto |
$1,264.40
|
|
|
paliperidone REF790856
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
2200208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
paliperidone REF790856
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
2200208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$65.26
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$150.60
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.88
|
| Rate for Payer: United Healthcare Commercial |
$213.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$125.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
PAMIDRONATE DISODIUM IV 3MG/ML
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
3300688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
PAMIDRONATE DISODIUM IV 3MG/ML
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
3300688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$10.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$24.18
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.80
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
PANCREASE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 00045034660
|
| Hospital Charge Code |
3300966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$19.55
|
| Rate for Payer: First Health Commercial |
$20.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20.70
|
| Rate for Payer: GEHA Commercial |
$18.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20.70
|
| Rate for Payer: Humana ChoiceCare |
$5.98
|
| Rate for Payer: Multiplan All |
$20.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.80
|
| Rate for Payer: OMNI Networks Commercial |
$16.10
|
| Rate for Payer: One Health Plan PPO/POS |
$20.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21.85
|
| Rate for Payer: Three Rivers Provider Network All |
$17.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$21.39
|
| Rate for Payer: Zelis Auto |
$9.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
PANCREASE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 00045034660
|
| Hospital Charge Code |
3300966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$19.55
|
| Rate for Payer: First Health Commercial |
$20.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20.70
|
| Rate for Payer: GEHA Commercial |
$16.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20.70
|
| Rate for Payer: Multiplan All |
$20.93
|
| Rate for Payer: OMNI Networks Commercial |
$16.10
|
| Rate for Payer: One Health Plan PPO/POS |
$20.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21.85
|
| Rate for Payer: Three Rivers Provider Network All |
$17.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$21.39
|
| Rate for Payer: Zelis Auto |
$9.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
PANCREATECTOMY
|
Facility
|
OP
|
$6,130.00
|
|
|
Service Code
|
CPT 48154
|
| Hospital Charge Code |
6148154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,532.50 |
| Max. Negotiated Rate |
$5,823.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,678.00
|
| Rate for Payer: Cash Price |
$3,678.00
|
| Rate for Payer: Cigna Commercial |
$5,210.50
|
| Rate for Payer: First Health Commercial |
$5,517.00
|
| Rate for Payer: First Health Workers Compensation |
$2,366.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,517.00
|
| Rate for Payer: GEHA Commercial |
$4,904.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,517.00
|
| Rate for Payer: Humana ChoiceCare |
$1,593.80
|
| Rate for Payer: Multiplan All |
$5,578.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,678.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,291.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,517.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,823.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,597.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,394.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,532.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,700.90
|
| Rate for Payer: Zelis Auto |
$2,452.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,065.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,673.49
|
|
|
PANCREATECTOMY
|
Facility
|
IP
|
$6,055.00
|
|
|
Service Code
|
CPT 48152
|
| Hospital Charge Code |
6148152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,653.02 |
| Max. Negotiated Rate |
$5,752.25 |
| Rate for Payer: Cash Price |
$3,633.00
|
| Rate for Payer: Cigna Commercial |
$5,146.75
|
| Rate for Payer: First Health Commercial |
$5,449.50
|
| Rate for Payer: First Health Workers Compensation |
$2,337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,449.50
|
| Rate for Payer: GEHA Commercial |
$4,238.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,449.50
|
| Rate for Payer: Multiplan All |
$5,510.05
|
| Rate for Payer: OMNI Networks Commercial |
$4,238.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,449.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,752.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,541.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,631.15
|
| Rate for Payer: Zelis Auto |
$2,422.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,653.02
|
|
|
PANCREATECTOMY
|
Facility
|
OP
|
$3,946.00
|
|
|
Service Code
|
CPT 48146
|
| Hospital Charge Code |
6148146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$986.50 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$1,523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$3,156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Humana ChoiceCare |
$1,025.96
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,367.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,472.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$986.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,973.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,077.26
|
|
|
PANCREATECTOMY
|
Facility
|
OP
|
$6,055.00
|
|
|
Service Code
|
CPT 48152
|
| Hospital Charge Code |
6148152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,513.75 |
| Max. Negotiated Rate |
$5,752.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,633.00
|
| Rate for Payer: Cash Price |
$3,633.00
|
| Rate for Payer: Cigna Commercial |
$5,146.75
|
| Rate for Payer: First Health Commercial |
$5,449.50
|
| Rate for Payer: First Health Workers Compensation |
$2,337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,449.50
|
| Rate for Payer: GEHA Commercial |
$4,844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,449.50
|
| Rate for Payer: Humana ChoiceCare |
$1,574.30
|
| Rate for Payer: Multiplan All |
$5,510.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,633.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,238.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,449.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,752.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,541.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,328.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,631.15
|
| Rate for Payer: Zelis Auto |
$2,422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,027.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,653.02
|
|
|
PANCREATECTOMY
|
Facility
|
IP
|
$3,946.00
|
|
|
Service Code
|
CPT 48146
|
| Hospital Charge Code |
6148146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,077.26 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$1,523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$2,762.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,077.26
|
|
|
PANCREATECTOMY
|
Facility
|
IP
|
$6,130.00
|
|
|
Service Code
|
CPT 48154
|
| Hospital Charge Code |
6148154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,673.49 |
| Max. Negotiated Rate |
$5,823.50 |
| Rate for Payer: Cash Price |
$3,678.00
|
| Rate for Payer: Cigna Commercial |
$5,210.50
|
| Rate for Payer: First Health Commercial |
$5,517.00
|
| Rate for Payer: First Health Workers Compensation |
$2,366.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,517.00
|
| Rate for Payer: GEHA Commercial |
$4,291.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,517.00
|
| Rate for Payer: Multiplan All |
$5,578.30
|
| Rate for Payer: OMNI Networks Commercial |
$4,291.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,517.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,823.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,597.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,700.90
|
| Rate for Payer: Zelis Auto |
$2,452.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,673.49
|
|
|
PANCREATECTOMY
|
Facility
|
OP
|
$6,534.00
|
|
|
Service Code
|
CPT 48153
|
| Hospital Charge Code |
6148153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,633.50 |
| Max. Negotiated Rate |
$6,207.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,920.40
|
| Rate for Payer: Cash Price |
$3,920.40
|
| Rate for Payer: Cigna Commercial |
$5,553.90
|
| Rate for Payer: First Health Commercial |
$5,880.60
|
| Rate for Payer: First Health Workers Compensation |
$2,522.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,880.60
|
| Rate for Payer: GEHA Commercial |
$5,227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,880.60
|
| Rate for Payer: Humana ChoiceCare |
$1,698.84
|
| Rate for Payer: Multiplan All |
$5,945.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,920.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,573.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,880.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,207.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,900.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,749.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,633.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,076.62
|
| Rate for Payer: Zelis Auto |
$2,613.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,267.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,783.78
|
|
|
PANCREATECTOMY
|
Facility
|
IP
|
$6,534.00
|
|
|
Service Code
|
CPT 48153
|
| Hospital Charge Code |
6148153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,783.78 |
| Max. Negotiated Rate |
$6,207.30 |
| Rate for Payer: Cash Price |
$3,920.40
|
| Rate for Payer: Cigna Commercial |
$5,553.90
|
| Rate for Payer: First Health Commercial |
$5,880.60
|
| Rate for Payer: First Health Workers Compensation |
$2,522.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,880.60
|
| Rate for Payer: GEHA Commercial |
$4,573.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,880.60
|
| Rate for Payer: Multiplan All |
$5,945.94
|
| Rate for Payer: OMNI Networks Commercial |
$4,573.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,880.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,207.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,900.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,076.62
|
| Rate for Payer: Zelis Auto |
$2,613.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,783.78
|
|
|
pancreatic elastase fecal REF 123234
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
2200855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$22.97
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$25.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$523.20
|
| Rate for Payer: GEHA Medicare |
$22.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Humana ChoiceCare |
$25.27
|
| Rate for Payer: Humana Medicare Advantage |
$22.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$38.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$22.97
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.05
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$22.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$45.94
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.51
|
| Rate for Payer: United Healthcare Commercial |
$555.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$22.97
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Medicare |
$19.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.56
|
| Rate for Payer: Zelis Worker's Compensation |
$18.33
|
|
|
pancreatic elastase fecal REF 123234
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
2200855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$25.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$457.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Worker's Compensation |
$18.33
|
|
|
PANCREATORRHAPHY
|
Facility
|
OP
|
$2,806.00
|
|
|
Service Code
|
CPT 48545
|
| Hospital Charge Code |
6148545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$701.50 |
| Max. Negotiated Rate |
$2,665.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,683.60
|
| Rate for Payer: Cash Price |
$1,683.60
|
| Rate for Payer: Cigna Commercial |
$2,385.10
|
| Rate for Payer: First Health Commercial |
$2,525.40
|
| Rate for Payer: First Health Workers Compensation |
$1,083.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,525.40
|
| Rate for Payer: GEHA Commercial |
$2,244.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,525.40
|
| Rate for Payer: Humana ChoiceCare |
$729.56
|
| Rate for Payer: Multiplan All |
$2,553.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,683.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,964.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,525.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,665.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,104.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,469.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$701.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,609.58
|
| Rate for Payer: Zelis Auto |
$1,122.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,403.00
|
| Rate for Payer: Zelis Worker's Compensation |
$766.04
|
|
|
PANCREATORRHAPHY
|
Facility
|
IP
|
$2,806.00
|
|
|
Service Code
|
CPT 48545
|
| Hospital Charge Code |
6148545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$766.04 |
| Max. Negotiated Rate |
$2,665.70 |
| Rate for Payer: Cash Price |
$1,683.60
|
| Rate for Payer: Cigna Commercial |
$2,385.10
|
| Rate for Payer: First Health Commercial |
$2,525.40
|
| Rate for Payer: First Health Workers Compensation |
$1,083.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,525.40
|
| Rate for Payer: GEHA Commercial |
$1,964.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,525.40
|
| Rate for Payer: Multiplan All |
$2,553.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,964.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,525.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,665.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,104.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,609.58
|
| Rate for Payer: Zelis Auto |
$1,122.40
|
| Rate for Payer: Zelis Worker's Compensation |
$766.04
|
|
|
PANCRELIPASE 12000 UNITS DR CAP
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
NDC 00032121201
|
| Hospital Charge Code |
3302978
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
PANCRELIPASE 12000 UNITS DR CAP
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
NDC 00032121201
|
| Hospital Charge Code |
3302978
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$25.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$8.32
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.20
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
PANTOPRAZOLE 40MG EC TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
3300689
|
|
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
|
|
