|
SECRETIN ACETATE FOR INJ 16MCG
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT J2850
|
| Hospital Charge Code |
3300815
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,416.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$40.52
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: First Health Workers Compensation |
$911.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,888.00
|
| Rate for Payer: GEHA Medicare |
$40.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Humana ChoiceCare |
$44.57
|
| Rate for Payer: Humana Medicare Advantage |
$40.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$68.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$44.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$40.52
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$68.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$51.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$44.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$40.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$81.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$40.52
|
| Rate for Payer: Zelis Auto |
$944.00
|
| Rate for Payer: Zelis Medicare |
$34.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$48.62
|
| Rate for Payer: Zelis Worker's Compensation |
$644.28
|
|
|
SECRETIN ACETATE FOR INJ 16MCG
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT J2850
|
| Hospital Charge Code |
3300815
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: First Health Workers Compensation |
$911.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
| Rate for Payer: Zelis Worker's Compensation |
$644.28
|
|
|
SEDRATE AUTOMATED
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
2205650
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$6.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.32
|
|
|
SEDRATE AUTOMATED
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
2205650
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$6.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$2.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$2.97
|
| Rate for Payer: Humana Medicare Advantage |
$2.70
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.70
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.59
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5.40
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.65
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.70
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$2.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.24
|
| Rate for Payer: Zelis Worker's Compensation |
$4.32
|
|
|
SELENIUM RBC REF
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
2300071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$44.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$25.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$28.08
|
| Rate for Payer: Humana Medicare Advantage |
$25.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.53
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.40
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$51.06
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.02
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.53
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$21.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.64
|
| Rate for Payer: Zelis Worker's Compensation |
$31.55
|
|
|
SELENIUM RBC REF
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
2300071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$44.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$31.55
|
|
|
SELENIUM SULFIDE 1% SHAMPOO
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 00536199553
|
| Hospital Charge Code |
3301406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$22.10
|
| Rate for Payer: First Health Commercial |
$23.40
|
| Rate for Payer: First Health Workers Compensation |
$10.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23.40
|
| Rate for Payer: GEHA Commercial |
$18.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23.40
|
| Rate for Payer: Multiplan All |
$23.66
|
| Rate for Payer: OMNI Networks Commercial |
$18.20
|
| Rate for Payer: One Health Plan PPO/POS |
$23.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$24.70
|
| Rate for Payer: Three Rivers Provider Network All |
$19.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24.18
|
| Rate for Payer: Zelis Auto |
$10.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.10
|
|
|
SELENIUM SULFIDE 1% SHAMPOO
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 00536199553
|
| Hospital Charge Code |
3301406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$22.10
|
| Rate for Payer: First Health Commercial |
$23.40
|
| Rate for Payer: First Health Workers Compensation |
$10.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23.40
|
| Rate for Payer: GEHA Commercial |
$20.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23.40
|
| Rate for Payer: Humana ChoiceCare |
$6.76
|
| Rate for Payer: Multiplan All |
$23.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.60
|
| Rate for Payer: OMNI Networks Commercial |
$18.20
|
| Rate for Payer: One Health Plan PPO/POS |
$23.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$24.70
|
| Rate for Payer: Three Rivers Provider Network All |
$19.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24.18
|
| Rate for Payer: Zelis Auto |
$10.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.10
|
|
|
selenium whole blood REF081034
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
2200112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$44.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$25.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$28.08
|
| Rate for Payer: Humana Medicare Advantage |
$25.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.53
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.40
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$51.06
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.02
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.53
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$21.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.64
|
| Rate for Payer: Zelis Worker's Compensation |
$31.55
|
|
|
selenium whole blood REF081034
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
2200112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$44.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$31.55
|
|
|
semen analysis post vasectomy REF519020
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
2209221
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$25.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$68.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$17.98
|
|
|
semen analysis post vasectomy REF519020
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
2209221
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$25.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$17.98
|
|
|
SEMEN COUNT
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
9200020
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$25.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$17.98
|
|
|
SEMEN COUNT
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
9200020
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$25.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$68.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$17.98
|
|
|
SENNOSIDES TAB 8.6MG
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
3300816
|
|
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
|
|
|
SENNOSIDES TAB 8.6MG
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
3300816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
SENS ADDITIONAL DRUG
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 87904
|
| Hospital Charge Code |
2299063
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$66.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Worker's Compensation |
$46.97
|
|
|
SENS ADDITIONAL DRUG
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 87904
|
| Hospital Charge Code |
2299063
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$37.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$66.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: GEHA Medicare |
$26.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$28.68
|
| Rate for Payer: Humana Medicare Advantage |
$26.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$43.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$26.07
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$44.32
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$26.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$52.14
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.55
|
| Rate for Payer: United Healthcare Commercial |
$164.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$26.07
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Medicare |
$22.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$31.28
|
| Rate for Payer: Zelis Worker's Compensation |
$46.97
|
|
|
SENSITIVITY - MIC
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2207186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
SENSITIVITY - MIC
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2207186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: GEHA Medicare |
$8.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$9.52
|
| Rate for Payer: Humana Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.65
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.71
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.30
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$158.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.65
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Medicare |
$7.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.38
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
serotonin release assay REF150018
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$24.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.09
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.18
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.09
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$20.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.91
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
serotonin release assay REF150018
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2200547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.46
|
|
|
SERTRALINE HCL 50MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
3300819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
SERTRALINE HCL 50MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
3300819
|
|
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
|
|
|
sesame seed IgE REF602485
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299197
|
|
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
|
|
