|
CUT DOWN VENIPUNCTURE <1YR
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
8136420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
CUT DOWN VENIPUNCTURE <1YR
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
8136420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$87.10
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.00
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$294.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$83.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$167.50
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
CUTTER LINEAR RELOAD 100MM
|
Facility
|
IP
|
$573.68
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.47 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$458.94
|
| Rate for Payer: Cash Price |
$344.21
|
| Rate for Payer: Cash Price |
$344.21
|
| Rate for Payer: Cigna Commercial |
$487.63
|
| Rate for Payer: First Health Commercial |
$516.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.31
|
| Rate for Payer: GEHA Commercial |
$401.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.31
|
| Rate for Payer: Multiplan All |
$522.05
|
| Rate for Payer: OMNI Networks Commercial |
$401.58
|
| Rate for Payer: One Health Plan PPO/POS |
$516.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.00
|
| Rate for Payer: Three Rivers Provider Network All |
$430.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.52
|
| Rate for Payer: Zelis Auto |
$229.47
|
|
|
CUTTER LINEAR RELOAD 100MM
|
Facility
|
OP
|
$573.68
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.21
|
| Rate for Payer: Cash Price |
$344.21
|
| Rate for Payer: Cash Price |
$344.21
|
| Rate for Payer: Cigna Commercial |
$487.63
|
| Rate for Payer: First Health Commercial |
$516.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.31
|
| Rate for Payer: GEHA Commercial |
$458.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.31
|
| Rate for Payer: Humana ChoiceCare |
$149.16
|
| Rate for Payer: Multiplan All |
$522.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$344.21
|
| Rate for Payer: OMNI Networks Commercial |
$401.58
|
| Rate for Payer: One Health Plan PPO/POS |
$516.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.00
|
| Rate for Payer: Three Rivers Provider Network All |
$430.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$504.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.52
|
| Rate for Payer: Zelis Auto |
$229.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$286.84
|
|
|
CUTTER LINEAR RELOAD TCD75
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
|
|
CUTTER LINEAR RELOAD TCD75
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$437.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
|
|
CUTTER LINEAR RELOAD TCR75
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
|
|
CUTTER LINEAR RELOAD TCR75
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$437.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
|
|
CUTTER LINEAR STAPLE TLC75
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$437.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
|
|
CUTTER LINEAR STAPLE TLC75
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
|
|
CYANIDE ANTIDOTE KIT
|
Facility
|
OP
|
$3,196.00
|
|
|
Service Code
|
NDC 11098050701
|
| Hospital Charge Code |
3300212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$799.00 |
| Max. Negotiated Rate |
$3,036.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,917.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cigna Commercial |
$2,716.60
|
| Rate for Payer: First Health Commercial |
$2,876.40
|
| Rate for Payer: First Health Workers Compensation |
$1,233.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,876.40
|
| Rate for Payer: GEHA Commercial |
$2,556.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,876.40
|
| Rate for Payer: Humana ChoiceCare |
$830.96
|
| Rate for Payer: Multiplan All |
$2,908.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,917.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,237.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,876.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,036.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,397.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,812.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$799.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,972.28
|
| Rate for Payer: Zelis Auto |
$1,278.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,598.00
|
| Rate for Payer: Zelis Worker's Compensation |
$872.51
|
|
|
CYANIDE ANTIDOTE KIT
|
Facility
|
IP
|
$3,196.00
|
|
|
Service Code
|
NDC 11098050701
|
| Hospital Charge Code |
3300212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$872.51 |
| Max. Negotiated Rate |
$3,036.20 |
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cigna Commercial |
$2,716.60
|
| Rate for Payer: First Health Commercial |
$2,876.40
|
| Rate for Payer: First Health Workers Compensation |
$1,233.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,876.40
|
| Rate for Payer: GEHA Commercial |
$2,237.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,876.40
|
| Rate for Payer: Multiplan All |
$2,908.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,237.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,876.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,036.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,397.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,972.28
|
| Rate for Payer: Zelis Auto |
$1,278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$872.51
|
|
|
CYANOCOBALAMIN INJ 1000MCG/ML
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
3300213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$1.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Humana ChoiceCare |
$9.62
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.20
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
CYANOCOBALAMIN INJ 1000MCG/ML
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
3300213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$25.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
CYANOCOBALAMIN TAB 1000MCG
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
3300214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CYANOCOBALAMIN TAB 1000MCG
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
3300214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CYCLOBENZAPRINE HCL TAB 10MG
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 69097084607
|
| Hospital Charge Code |
3300215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
CYCLOBENZAPRINE HCL TAB 10MG
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 69097084607
|
| Hospital Charge Code |
3300215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
cyclospora smear stool REF183145
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
2200424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$12.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.72
|
|
|
cyclospora smear stool REF183145
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
2200424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$12.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$6.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$7.35
|
| Rate for Payer: Humana Medicare Advantage |
$6.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.68
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.36
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.36
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.55
|
| Rate for Payer: United Healthcare Commercial |
$263.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.68
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$5.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.02
|
| Rate for Payer: Zelis Worker's Compensation |
$8.72
|
|
|
cyclosporine, wb REF706556
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
2200083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.84 |
| 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 |
$30.89
|
| 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 |
$21.84
|
|
|
cyclosporine, wb REF706556
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
2200083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.49
|
| 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 |
$32.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.05
|
| 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 |
$30.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$18.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$19.86
|
| Rate for Payer: Humana Medicare Advantage |
$18.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.05
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.68
|
| 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 |
$30.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.69
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.05
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$15.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.66
|
| Rate for Payer: Zelis Worker's Compensation |
$21.84
|
|
|
CYPROHEPTADINE HCL 4 MG TAB
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 52817021010
|
| Hospital Charge Code |
3300216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CYPROHEPTADINE HCL 4 MG TAB
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 52817021010
|
| Hospital Charge Code |
3300216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CYSTATIN C REF
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
2300030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.33
|
| 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 |
$33.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.52
|
| 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 |
$30.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$18.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$20.37
|
| Rate for Payer: Humana Medicare Advantage |
$18.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.52
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.48
|
| 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 |
$31.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.04
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.15
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.52
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$15.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.22
|
| Rate for Payer: Zelis Worker's Compensation |
$21.64
|
|
