|
NiCARdipine 25 MG/10 ML SDV -IVPB only
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
NDC 00143968910
|
| Hospital Charge Code |
3302903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$73.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Worker's Compensation |
$52.14
|
|
|
NiCARdipine 25 MG/10 ML SDV -IVPB only
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
NDC 00143968910
|
| Hospital Charge Code |
3302903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$73.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Humana ChoiceCare |
$49.66
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.60
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.50
|
| Rate for Payer: Zelis Worker's Compensation |
$52.14
|
|
|
NiCARdipine 25 MG/NS 250 ML IVPB
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3302904
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$296.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
NiCARdipine 25 MG/NS 250 ML IVPB
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3302904
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$338.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Humana ChoiceCare |
$109.98
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$253.80
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$372.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$211.50
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
niCARdipine IV SOLN 20MG/200ML
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
3300642
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$338.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Humana ChoiceCare |
$109.98
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$253.80
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$372.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$211.50
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
niCARdipine IV SOLN 20MG/200ML
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
NDC 10122031310
|
| Hospital Charge Code |
3300642
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$359.55
|
| Rate for Payer: First Health Commercial |
$380.70
|
| Rate for Payer: First Health Workers Compensation |
$163.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$380.70
|
| Rate for Payer: GEHA Commercial |
$296.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$380.70
|
| Rate for Payer: Multiplan All |
$384.93
|
| Rate for Payer: OMNI Networks Commercial |
$296.10
|
| Rate for Payer: One Health Plan PPO/POS |
$380.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$401.85
|
| Rate for Payer: Three Rivers Provider Network All |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.39
|
| Rate for Payer: Zelis Auto |
$169.20
|
| Rate for Payer: Zelis Worker's Compensation |
$115.48
|
|
|
nicotine and cotinine, blood REF071255
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
2247352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$34.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
nicotine and cotinine, blood REF071255
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
2247352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Humana ChoiceCare |
$12.74
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.40
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$43.12
|
| Rate for Payer: United Healthcare Commercial |
$41.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
nicotine metablite,urine,screenREF716555
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
22003427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
nicotine metablite,urine,screenREF716555
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
22003427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
NICOTINE TD PATCH 24HR 14MG/24HR
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
3300643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
NICOTINE TD PATCH 24HR 14MG/24HR
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 00536589588
|
| Hospital Charge Code |
3300643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
NICOTINE TD PATCH 24HR 21MG/24HR
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
3300644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
NICOTINE TD PATCH 24HR 21MG/24HR
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 43598044871
|
| Hospital Charge Code |
3300644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
NIFEdipine 10MG CAP
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
3300646
|
|
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
|
|
|
NIFEdipine 10MG CAP
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 23155019401
|
| Hospital Charge Code |
3300646
|
|
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
|
|
|
NIFEdipine 30MG SR 24HR TAB
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 50268059715
|
| Hospital Charge Code |
3300647
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
NIFEdipine 30MG SR 24HR TAB
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 50268059715
|
| Hospital Charge Code |
3300647
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
NIMODIPINE CAP 30MG
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
3300648
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$44.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.12
|
|
|
NIMODIPINE CAP 30MG
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
3300648
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$44.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$29.64
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$68.40
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$57.00
|
| Rate for Payer: Zelis Worker's Compensation |
$31.12
|
|
|
NIPPLE EXPLORATION
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 19110
|
| Hospital Charge Code |
6119110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
NIPPLE EXPLORATION
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 19110
|
| Hospital Charge Code |
6119110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
NITROFURANTOIN 50MG CAP
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 47781030701
|
| Hospital Charge Code |
3300649
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$4.68
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.80
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
NITROFURANTOIN 50MG CAP
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 47781030701
|
| Hospital Charge Code |
3300649
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
NITROFURANTOIN IR 100 MG CAP
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 50268062415
|
| Hospital Charge Code |
3302964
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
