|
NAFCILLIN SODIUM FOR INJ 1GM
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
NDC 55150012215
|
| Hospital Charge Code |
3300629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$36.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$75.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Humana ChoiceCare |
$24.44
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$56.40
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$82.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.66
|
|
|
NAIL FLEXIBLE PEDI 1.5X300MM
|
Facility
|
OP
|
$1,174.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.61 |
| Max. Negotiated Rate |
$1,115.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.65
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cigna Commercial |
$998.26
|
| Rate for Payer: First Health Commercial |
$1,056.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,056.98
|
| Rate for Payer: GEHA Commercial |
$939.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,056.98
|
| Rate for Payer: Humana ChoiceCare |
$305.35
|
| Rate for Payer: Multiplan All |
$1,068.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$704.65
|
| Rate for Payer: OMNI Networks Commercial |
$822.09
|
| Rate for Payer: One Health Plan PPO/POS |
$1,056.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,115.70
|
| Rate for Payer: Three Rivers Provider Network All |
$880.82
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,033.49
|
| Rate for Payer: United Healthcare Managed Medicaid |
$293.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.21
|
| Rate for Payer: Zelis Auto |
$469.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$587.21
|
|
|
NAIL FLEXIBLE PEDI 1.5X300MM
|
Facility
|
IP
|
$1,174.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.77 |
| Max. Negotiated Rate |
$1,115.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$939.54
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cigna Commercial |
$998.26
|
| Rate for Payer: First Health Commercial |
$1,056.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,056.98
|
| Rate for Payer: GEHA Commercial |
$822.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,056.98
|
| Rate for Payer: Multiplan All |
$1,068.72
|
| Rate for Payer: OMNI Networks Commercial |
$822.09
|
| Rate for Payer: One Health Plan PPO/POS |
$1,056.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,115.70
|
| Rate for Payer: Three Rivers Provider Network All |
$880.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.21
|
| Rate for Payer: Zelis Auto |
$469.77
|
|
|
NAIL FLEXIBLE PEDI 1.75X300MM
|
Facility
|
IP
|
$1,174.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.77 |
| Max. Negotiated Rate |
$1,115.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$939.54
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cigna Commercial |
$998.26
|
| Rate for Payer: First Health Commercial |
$1,056.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,056.98
|
| Rate for Payer: GEHA Commercial |
$822.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,056.98
|
| Rate for Payer: Multiplan All |
$1,068.72
|
| Rate for Payer: OMNI Networks Commercial |
$822.09
|
| Rate for Payer: One Health Plan PPO/POS |
$1,056.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,115.70
|
| Rate for Payer: Three Rivers Provider Network All |
$880.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.21
|
| Rate for Payer: Zelis Auto |
$469.77
|
|
|
NAIL FLEXIBLE PEDI 1.75X300MM
|
Facility
|
OP
|
$1,174.42
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.61 |
| Max. Negotiated Rate |
$1,115.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.65
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cash Price |
$704.65
|
| Rate for Payer: Cigna Commercial |
$998.26
|
| Rate for Payer: First Health Commercial |
$1,056.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,056.98
|
| Rate for Payer: GEHA Commercial |
$939.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,056.98
|
| Rate for Payer: Humana ChoiceCare |
$305.35
|
| Rate for Payer: Multiplan All |
$1,068.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$704.65
|
| Rate for Payer: OMNI Networks Commercial |
$822.09
|
| Rate for Payer: One Health Plan PPO/POS |
$1,056.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,115.70
|
| Rate for Payer: Three Rivers Provider Network All |
$880.82
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,033.49
|
| Rate for Payer: United Healthcare Managed Medicaid |
$293.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.21
|
| Rate for Payer: Zelis Auto |
$469.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$587.21
|
|
|
NAIL FLEXIBLE PED WIN 2.5MM
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.20 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$982.40
|
| 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: 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
|
|
|
NAIL FLEXIBLE PED WIN 2.5MM
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$736.80
|
| 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: Galaxy Health Commercial/Workers Compensation |
$1,105.20
|
| Rate for Payer: GEHA Commercial |
$982.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,105.20
|
| Rate for Payer: Humana ChoiceCare |
$319.28
|
| 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: 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 |
$307.00
|
| 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
|
|
|
NAIL TRIGEN 13MM X 20CM
|
Facility
|
IP
|
$3,726.75
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.70 |
| Max. Negotiated Rate |
$3,540.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,981.40
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cigna Commercial |
$3,167.74
|
| Rate for Payer: First Health Commercial |
$3,354.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,354.07
|
| Rate for Payer: GEHA Commercial |
$2,608.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,354.07
|
| Rate for Payer: Multiplan All |
$3,391.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,608.72
|
| Rate for Payer: One Health Plan PPO/POS |
$3,354.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,540.41
|
| Rate for Payer: Three Rivers Provider Network All |
$2,795.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,465.88
|
| Rate for Payer: Zelis Auto |
$1,490.70
|
|
|
NAIL TRIGEN 13MM X 20CM
|
Facility
|
OP
|
$3,726.75
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.69 |
| Max. Negotiated Rate |
$3,540.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,236.05
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cigna Commercial |
$3,167.74
|
| Rate for Payer: First Health Commercial |
$3,354.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,354.07
|
| Rate for Payer: GEHA Commercial |
$2,981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,354.07
|
| Rate for Payer: Humana ChoiceCare |
$968.96
|
| Rate for Payer: Multiplan All |
$3,391.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,236.05
|
| Rate for Payer: OMNI Networks Commercial |
$2,608.72
|
| Rate for Payer: One Health Plan PPO/POS |
$3,354.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,540.41
|
| Rate for Payer: Three Rivers Provider Network All |
$2,795.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,279.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$931.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,465.88
|
| Rate for Payer: Zelis Auto |
$1,490.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,863.38
|
|
|
NALOXONE HCL 0.4 MG/ML INJ
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
3300630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NALOXONE HCL 0.4 MG/ML INJ
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
3300630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NALTREXONE HCL 50 MG TAB
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3303220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
NALTREXONE HCL 50 MG TAB
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3303220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
NAPROXEN SODIUM TAB 220MG
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 25866010501
|
| Hospital Charge Code |
3300631
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
NAPROXEN SODIUM TAB 220MG
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 25866010501
|
| Hospital Charge Code |
3300631
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
NAPROXEN TAB 500MG
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
3300632
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
NAPROXEN TAB 500MG
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
3300632
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
NARCAN 2 MG/2 ML INJ SYR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
3301367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$63.70
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$147.00
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$215.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$61.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$122.50
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
NARCAN 2 MG/2 ML INJ SYR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
3301367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
NARCOSYNTHESIS
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
8590865
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$183.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$333.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Worker's Compensation |
$129.95
|
|
|
NARCOSYNTHESIS
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
8590865
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$183.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$136.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$157.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$136.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Commercial |
$404.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$129.95
|
|
|
NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
9599240
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
9599240
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$136.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$157.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$136.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
8499240
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
8499240
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$136.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$157.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
