|
HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDU
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
23500054
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$530.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,809.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$707.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,846.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,132.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,846.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,846.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDU
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
23500054
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$618.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
OP
|
$5,742.54
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
6158563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,567.71 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,763.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,445.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,763.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,981.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$3,445.52
|
| Rate for Payer: Cash Price |
$3,445.52
|
| Rate for Payer: Cigna Commercial |
$4,881.16
|
| Rate for Payer: First Health Commercial |
$5,168.29
|
| Rate for Payer: First Health Workers Compensation |
$2,217.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,168.29
|
| Rate for Payer: GEHA Commercial |
$4,594.03
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,168.29
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,041.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$5,225.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$4,019.78
|
| Rate for Payer: One Health Plan PPO/POS |
$5,168.29
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,512.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,041.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,455.41
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$4,306.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,041.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,340.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$2,297.02
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$1,567.71
|
|
|
HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$5,742.54
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
6158563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,567.71 |
| Max. Negotiated Rate |
$5,455.41 |
| Rate for Payer: Cash Price |
$3,445.52
|
| Rate for Payer: Cigna Commercial |
$4,881.16
|
| Rate for Payer: First Health Commercial |
$5,168.29
|
| Rate for Payer: First Health Workers Compensation |
$2,217.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,168.29
|
| Rate for Payer: GEHA Commercial |
$4,019.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,168.29
|
| Rate for Payer: Multiplan All |
$5,225.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,019.78
|
| Rate for Payer: One Health Plan PPO/POS |
$5,168.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,455.41
|
| Rate for Payer: Three Rivers Provider Network All |
$4,306.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,340.56
|
| Rate for Payer: Zelis Auto |
$2,297.02
|
| Rate for Payer: Zelis Worker's Compensation |
$1,567.71
|
|
|
HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
6158561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$786.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
6158561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,763.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,763.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,981.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$898.40
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,041.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,512.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,041.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,041.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
HYSTEROSCOPY, STERILIZATION
|
Facility
|
OP
|
$1,345.00
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
6158565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$367.19 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$807.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cigna Commercial |
$1,143.25
|
| Rate for Payer: First Health Commercial |
$1,210.50
|
| Rate for Payer: First Health Workers Compensation |
$519.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,210.50
|
| Rate for Payer: GEHA Commercial |
$1,076.00
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,210.50
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,223.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$941.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,210.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,277.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,008.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,250.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$538.00
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$367.19
|
|
|
HYSTEROSCOPY, STERILIZATION
|
Facility
|
IP
|
$1,345.00
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
6158565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$367.19 |
| Max. Negotiated Rate |
$1,277.75 |
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cigna Commercial |
$1,143.25
|
| Rate for Payer: First Health Commercial |
$1,210.50
|
| Rate for Payer: First Health Workers Compensation |
$519.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,210.50
|
| Rate for Payer: GEHA Commercial |
$941.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,210.50
|
| Rate for Payer: Multiplan All |
$1,223.95
|
| Rate for Payer: OMNI Networks Commercial |
$941.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,210.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,277.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,008.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,250.85
|
| Rate for Payer: Zelis Auto |
$538.00
|
| Rate for Payer: Zelis Worker's Compensation |
$367.19
|
|
|
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,981.25 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,763.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,763.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,981.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,041.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,512.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,041.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,041.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$6,038.18
|
|
|
Service Code
|
CPT 58558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,809.64 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,809.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: First Health Workers Compensation |
$3,885.57
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,846.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,132.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,846.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,846.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$2,747.37
|
|
|
ia-2 autoantibodies REF 141531
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
2200565
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cigna Commercial |
$232.90
|
| Rate for Payer: First Health Commercial |
$246.60
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$246.60
|
| Rate for Payer: GEHA Commercial |
$191.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$246.60
|
| Rate for Payer: Multiplan All |
$249.34
|
| Rate for Payer: OMNI Networks Commercial |
$191.80
|
| Rate for Payer: One Health Plan PPO/POS |
$246.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$260.30
|
| Rate for Payer: Three Rivers Provider Network All |
$205.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$254.82
|
| Rate for Payer: Zelis Auto |
$109.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.04
|
|
|
ia-2 autoantibodies REF 141531
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
2200565
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$164.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cigna Commercial |
$232.90
|
| Rate for Payer: First Health Commercial |
$246.60
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$246.60
|
| Rate for Payer: GEHA Commercial |
$219.20
|
| Rate for Payer: GEHA Medicare |
$23.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$246.60
|
| Rate for Payer: Humana ChoiceCare |
$25.93
|
| Rate for Payer: Humana Medicare Advantage |
$23.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.57
|
| Rate for Payer: Multiplan All |
$249.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.07
|
| Rate for Payer: OMNI Networks Commercial |
$191.80
|
| Rate for Payer: One Health Plan PPO/POS |
$246.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$260.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$47.14
|
| Rate for Payer: Three Rivers Provider Network All |
$205.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$232.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$254.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.57
|
| Rate for Payer: Zelis Auto |
$109.60
|
| Rate for Payer: Zelis Medicare |
$20.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.28
|
| Rate for Payer: Zelis Worker's Compensation |
$22.04
|
|
|
IA INFECTIOUS AGT ANTIBODY SARS-COV-2 CO
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86328
|
| Hospital Charge Code |
2202041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$45.28
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$53.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$45.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$49.81
|
| Rate for Payer: Humana Medicare Advantage |
$45.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$76.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$45.28
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.98
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$45.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$90.56
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.37
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$45.28
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$38.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.34
|
| Rate for Payer: Zelis Worker's Compensation |
$37.90
|
|
|
IA INFECTIOUS AGT ANTIBODY SARS-COV-2 CO
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86328
|
| Hospital Charge Code |
2202041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$53.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.90
|
|
|
IBANDRONATE SODIUM IV 3MG/3ML
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT J1740
|
| Hospital Charge Code |
3300436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.47 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$736.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.49
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cigna Commercial |
$1,043.80
|
| Rate for Payer: First Health Commercial |
$1,105.20
|
| Rate for Payer: First Health Workers Compensation |
$474.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,105.20
|
| Rate for Payer: GEHA Commercial |
$31.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,105.20
|
| Rate for Payer: Humana ChoiceCare |
$319.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.50
|
| Rate for Payer: Multiplan All |
$1,117.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$736.80
|
| Rate for Payer: OMNI Networks Commercial |
$859.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,105.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,166.60
|
| Rate for Payer: Three Rivers Provider Network All |
$921.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,080.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,142.04
|
| Rate for Payer: Zelis Auto |
$491.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$614.00
|
| Rate for Payer: Zelis Worker's Compensation |
$335.24
|
|
|
IBANDRONATE SODIUM IV 3MG/3ML
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT J1740
|
| Hospital Charge Code |
3300436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$335.24 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cigna Commercial |
$1,043.80
|
| Rate for Payer: First Health Commercial |
$1,105.20
|
| Rate for Payer: First Health Workers Compensation |
$474.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,105.20
|
| Rate for Payer: GEHA Commercial |
$859.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,105.20
|
| Rate for Payer: Multiplan All |
$1,117.48
|
| Rate for Payer: OMNI Networks Commercial |
$859.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,105.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,166.60
|
| Rate for Payer: Three Rivers Provider Network All |
$921.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,142.04
|
| Rate for Payer: Zelis Auto |
$491.20
|
| Rate for Payer: Zelis Worker's Compensation |
$335.24
|
|
|
IBUPROFEN 100MG/5ML SUSPENSION
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
IBUPROFEN 100MG/5ML SUSPENSION
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
IBUPROFEN 200MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3300441
|
|
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
|
|
|
IBUPROFEN 200MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3300441
|
|
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
|
|
|
IBUPROFEN 400MG TAB
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
IBUPROFEN 400MG TAB
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300442
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
IBUPROFEN 600MG TAB
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
IBUPROFEN 600MG TAB
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
IBUPROFEN 800MG TAB
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3300444
|
|
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
|
|
