|
ASPIRIN ENTERIC COATED 325MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ASPIRIN ENTERIC COATED 81MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ASPIRIN ENTERIC COATED 81MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ASPIR/INJ THYROID CYST
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
6160300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$132.60
|
| Rate for Payer: First Health Commercial |
$140.40
|
| Rate for Payer: First Health Workers Compensation |
$60.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.40
|
| Rate for Payer: GEHA Commercial |
$109.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.40
|
| Rate for Payer: Multiplan All |
$141.96
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: One Health Plan PPO/POS |
$140.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.20
|
| Rate for Payer: Three Rivers Provider Network All |
$117.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.08
|
| Rate for Payer: Zelis Auto |
$62.40
|
| Rate for Payer: Zelis Worker's Compensation |
$42.59
|
|
|
ASPIR/INJ THYROID CYST
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
6160300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$132.60
|
| Rate for Payer: First Health Commercial |
$140.40
|
| Rate for Payer: First Health Workers Compensation |
$60.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.40
|
| Rate for Payer: GEHA Commercial |
$124.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.40
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$141.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: One Health Plan PPO/POS |
$140.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$117.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$62.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$42.59
|
|
|
ASPIRIN RECTAL 300MG SUPPOSITORY
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
3302436
|
|
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
|
|
|
ASPIRIN RECTAL 300MG SUPPOSITORY
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 00574703412
|
| Hospital Charge Code |
3302436
|
|
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
|
|
|
ASSAY, GLUCOSE, BLOOD QUA
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
9400041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$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 |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$4.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.93
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
ASSAY, GLUCOSE, BLOOD QUA
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
9400041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$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 |
$7.76
|
| 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 |
$5.49
|
|
|
ASSESS CYST CONTRAST INJECT
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
6149424
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
ASSESS CYST CONTRAST INJECT
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
6149424
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$31.46
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.60
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$106.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.50
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
ASSESS HLTH/BEHAVE, SUBSEQ
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 96151
|
| Hospital Charge Code |
8596151
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
ASSESS HLTH/BEHAVE, SUBSEQ
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 96151
|
| Hospital Charge Code |
8596151
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$47.06
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.60
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
AST/SGOT (Vitros)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
2232198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$83.20
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$88.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
AST/SGOT (Vitros)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
2232198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
ATENOLOL 25MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
3300074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ATENOLOL 25MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 51079075901
|
| Hospital Charge Code |
3300074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ATORVASTATIN 20 MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
3300075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ATORVASTATIN 20 MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
3300075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ATROPINE 0.1MG/ML - ABBOJECT
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
3300076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
ATROPINE 0.1MG/ML - ABBOJECT
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
3300076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$0.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Humana ChoiceCare |
$21.84
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.40
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
ATROPINE SULFATE INJ 0.4MG/ML
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
3300077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ATROPINE SULFATE INJ 0.4MG/ML
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
3300077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$0.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.60
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
ATROPINE SULFATE INJ 1MG/ML
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
3300078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
ATROPINE SULFATE INJ 1MG/ML
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT J0461
|
| Hospital Charge Code |
3300078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$0.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
