|
cefTRIAXone SODIUM 250MG
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
3300160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
cefTRIAXone SOD (ROCEPHIN) VL: 1GM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
3300159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
cefTRIAXone SOD (ROCEPHIN) VL: 1GM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
3300159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$0.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
CEFUROXIME AXETIL 250MG TAB
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 67877021520
|
| Hospital Charge Code |
3300161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: First Health Commercial |
$31.50
|
| Rate for Payer: First Health Workers Compensation |
$13.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$31.50
|
| Rate for Payer: GEHA Commercial |
$24.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$31.50
|
| Rate for Payer: Multiplan All |
$31.85
|
| Rate for Payer: OMNI Networks Commercial |
$24.50
|
| Rate for Payer: One Health Plan PPO/POS |
$31.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$33.25
|
| Rate for Payer: Three Rivers Provider Network All |
$26.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$32.55
|
| Rate for Payer: Zelis Auto |
$14.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.55
|
|
|
CEFUROXIME AXETIL 250MG TAB
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 67877021520
|
| Hospital Charge Code |
3300161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$29.75
|
| Rate for Payer: First Health Commercial |
$31.50
|
| Rate for Payer: First Health Workers Compensation |
$13.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$31.50
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$31.50
|
| Rate for Payer: Humana ChoiceCare |
$9.10
|
| Rate for Payer: Multiplan All |
$31.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.00
|
| Rate for Payer: OMNI Networks Commercial |
$24.50
|
| Rate for Payer: One Health Plan PPO/POS |
$31.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$33.25
|
| Rate for Payer: Three Rivers Provider Network All |
$26.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$32.55
|
| Rate for Payer: Zelis Auto |
$14.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.50
|
| Rate for Payer: Zelis Worker's Compensation |
$9.55
|
|
|
CEFUROXIME AXETIL 500MG TAB
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
NDC 68180030320
|
| Hospital Charge Code |
3300162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| 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 |
$31.27
|
| 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 |
$22.11
|
|
|
CEFUROXIME AXETIL 500MG TAB
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
NDC 68180030320
|
| Hospital Charge Code |
3300162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
CELECOXIB 200MG CAP
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
3300163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
CELECOXIB 200MG CAP
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 00904650361
|
| Hospital Charge Code |
3300163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
CELECOXIB 50MG CAP
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
NDC 00025151501
|
| Hospital Charge Code |
3300164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
CELECOXIB 50MG CAP
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 00025151501
|
| Hospital Charge Code |
3300164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
cell count w/ diff, csf REF005256
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2200492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
cell count w/ diff, csf REF005256
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2200492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
cell count w/ diff, serous fl REF005240
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2200490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
cell count w/ diff, serous fl REF005240
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2200490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
cell count w/ diff,synovial fl REF215996
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2239403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
cell count w/ diff,synovial fl REF215996
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2239403
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
CEMENT,BONE,SIMPLEX,
|
Facility
|
IP
|
$1,257.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90009637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$1,194.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.60
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna Commercial |
$1,068.45
|
| Rate for Payer: First Health Commercial |
$1,131.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,131.30
|
| Rate for Payer: GEHA Commercial |
$879.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,131.30
|
| Rate for Payer: Multiplan All |
$1,143.87
|
| Rate for Payer: OMNI Networks Commercial |
$879.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,131.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,194.15
|
| Rate for Payer: Three Rivers Provider Network All |
$942.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.01
|
| Rate for Payer: Zelis Auto |
$502.80
|
|
|
CEMENT,BONE,SIMPLEX,
|
Facility
|
OP
|
$1,257.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90009637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$314.25 |
| Max. Negotiated Rate |
$1,194.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna Commercial |
$1,068.45
|
| Rate for Payer: First Health Commercial |
$1,131.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,131.30
|
| Rate for Payer: GEHA Commercial |
$1,005.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,131.30
|
| Rate for Payer: Humana ChoiceCare |
$326.82
|
| Rate for Payer: Multiplan All |
$1,143.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$754.20
|
| Rate for Payer: OMNI Networks Commercial |
$879.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,131.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,194.15
|
| Rate for Payer: Three Rivers Provider Network All |
$942.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,106.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$314.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.01
|
| Rate for Payer: Zelis Auto |
$502.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$628.50
|
|
|
CEPHALEXIN 250 MG cap
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
3300165
|
|
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
|
|
|
CEPHALEXIN 250 MG cap
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
3300165
|
|
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
|
|
|
CEPHALEXIN FOR SUSP 250MG/5ML
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
3300166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: First Health Workers Compensation |
$71.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$148.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Humana ChoiceCare |
$48.10
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$111.00
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$162.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$92.50
|
| Rate for Payer: Zelis Worker's Compensation |
$50.51
|
|
|
CEPHALEXIN FOR SUSP 250MG/5ML
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
3300166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.51 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: First Health Workers Compensation |
$71.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$129.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
| Rate for Payer: Zelis Worker's Compensation |
$50.51
|
|
|
ceruloplasmin REF001560
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
2247274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$18.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.20
|
|
|
ceruloplasmin REF001560
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
2247274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$18.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: GEHA Medicare |
$10.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$11.81
|
| Rate for Payer: Humana Medicare Advantage |
$10.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.74
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.26
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.48
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$102.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.74
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Medicare |
$9.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.89
|
| Rate for Payer: Zelis Worker's Compensation |
$13.20
|
|
