|
MEPERIDINE 25 MG/1 ML INJ
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
3303185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$37.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
MEPERIDINE HCL INJ 25MG/0.5ML
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
3302556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
MEPERIDINE HCL INJ 25MG/0.5ML
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
3302556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$17.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
MEPERIDINE HCL INJ 50MG/ML
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
3300566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$36.55
|
| Rate for Payer: First Health Commercial |
$38.70
|
| Rate for Payer: First Health Workers Compensation |
$16.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$38.70
|
| Rate for Payer: GEHA Commercial |
$17.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$38.70
|
| Rate for Payer: Humana ChoiceCare |
$11.18
|
| Rate for Payer: Multiplan All |
$39.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.80
|
| Rate for Payer: OMNI Networks Commercial |
$30.10
|
| Rate for Payer: One Health Plan PPO/POS |
$38.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$40.85
|
| Rate for Payer: Three Rivers Provider Network All |
$32.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$37.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.99
|
| Rate for Payer: Zelis Auto |
$17.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.74
|
|
|
MEPERIDINE HCL INJ 50MG/ML
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
3300566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$36.55
|
| Rate for Payer: First Health Commercial |
$38.70
|
| Rate for Payer: First Health Workers Compensation |
$16.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$38.70
|
| Rate for Payer: GEHA Commercial |
$30.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$38.70
|
| Rate for Payer: Multiplan All |
$39.13
|
| Rate for Payer: OMNI Networks Commercial |
$30.10
|
| Rate for Payer: One Health Plan PPO/POS |
$38.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$40.85
|
| Rate for Payer: Three Rivers Provider Network All |
$32.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.99
|
| Rate for Payer: Zelis Auto |
$17.20
|
| Rate for Payer: Zelis Worker's Compensation |
$11.74
|
|
|
MEPERIDINE HCL TAB 50MG
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 42806005030
|
| Hospital Charge Code |
3300567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
MEPERIDINE HCL TAB 50MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 42806005030
|
| Hospital Charge Code |
3300567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
MERCURY
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2247273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$89.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$119.20
|
| Rate for Payer: GEHA Medicare |
$16.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Humana ChoiceCare |
$17.89
|
| Rate for Payer: Humana Medicare Advantage |
$16.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.26
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.64
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.52
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.93
|
| Rate for Payer: United Healthcare Commercial |
$126.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.26
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Medicare |
$13.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.51
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
MERCURY
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2247273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$104.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
mercury urine REF007773
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2299993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$89.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$119.20
|
| Rate for Payer: GEHA Medicare |
$16.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Humana ChoiceCare |
$17.89
|
| Rate for Payer: Humana Medicare Advantage |
$16.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.26
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.64
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.52
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.93
|
| Rate for Payer: United Healthcare Commercial |
$126.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.26
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Medicare |
$13.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.51
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
mercury urine REF007773
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2299993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$28.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$104.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.12
|
|
|
MEROPENEM 1GM FOR IVPB
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
3300568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$74.80
|
| Rate for Payer: First Health Commercial |
$79.20
|
| Rate for Payer: First Health Workers Compensation |
$33.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.20
|
| Rate for Payer: GEHA Commercial |
$0.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.20
|
| Rate for Payer: Humana ChoiceCare |
$22.88
|
| Rate for Payer: Multiplan All |
$80.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.80
|
| Rate for Payer: OMNI Networks Commercial |
$61.60
|
| Rate for Payer: One Health Plan PPO/POS |
$79.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$83.60
|
| Rate for Payer: Three Rivers Provider Network All |
$66.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$77.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$81.84
|
| Rate for Payer: Zelis Auto |
$35.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.02
|
|
|
MEROPENEM 1GM FOR IVPB
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
3300568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$74.80
|
| Rate for Payer: First Health Commercial |
$79.20
|
| Rate for Payer: First Health Workers Compensation |
$33.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.20
|
| Rate for Payer: GEHA Commercial |
$61.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.20
|
| Rate for Payer: Multiplan All |
$80.08
|
| Rate for Payer: OMNI Networks Commercial |
$61.60
|
| Rate for Payer: One Health Plan PPO/POS |
$79.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$83.60
|
| Rate for Payer: Three Rivers Provider Network All |
$66.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$81.84
|
| Rate for Payer: Zelis Auto |
$35.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.02
|
|
|
MEROPENEM IV FOR SOLN 500MG
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
3300569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
MEROPENEM IV FOR SOLN 500MG
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
3300569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$0.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
MERTIATDE UP TO 15MC
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
2410059
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$349.99 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: First Health Workers Compensation |
$494.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$897.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
| Rate for Payer: Zelis Worker's Compensation |
$349.99
|
|
|
MERTIATDE UP TO 15MC
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT A9562
|
| Hospital Charge Code |
2410059
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: First Health Workers Compensation |
$494.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$1,025.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Humana ChoiceCare |
$333.32
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$769.20
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,128.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$641.00
|
| Rate for Payer: Zelis Worker's Compensation |
$349.99
|
|
|
MESALAMINE (CANASA) 1000MG SUPP
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
NDC 58914050156
|
| Hospital Charge Code |
3302450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$204.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Humana ChoiceCare |
$66.30
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.00
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.50
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
MESALAMINE (CANASA) 1000MG SUPP
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
NDC 58914050156
|
| Hospital Charge Code |
3302450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$178.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
MESALAMINE CAP ER 500MG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
NDC 54092019112
|
| Hospital Charge Code |
3300570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
MESALAMINE CAP ER 500MG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
NDC 54092019112
|
| Hospital Charge Code |
3300570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
MESALAMINE RECTAL SUSPN 4 GM/60 ML ENEMA
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
NDC 45802009846
|
| Hospital Charge Code |
3303138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
MESALAMINE RECTAL SUSPN 4 GM/60 ML ENEMA
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
NDC 45802009846
|
| Hospital Charge Code |
3303138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$57.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Humana ChoiceCare |
$18.72
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.20
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$63.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
MESH 3D MAX LARGE LEFT
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Humana ChoiceCare |
$354.64
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$818.40
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,200.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$341.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$682.00
|
|
|
MESH 3D MAX LARGE LEFT
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.60 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.20
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
|
