|
beta hcg subunit quant REF004416
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2200417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$27.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.60
|
|
|
BETA HYDROXYBUTYRATE (Vitros)
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
2232274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$15.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: GEHA Medicare |
$8.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Humana ChoiceCare |
$8.99
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.17
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.89
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.34
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.01
|
| Rate for Payer: United Healthcare Commercial |
$113.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.17
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Medicare |
$6.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.80
|
| Rate for Payer: Zelis Worker's Compensation |
$11.24
|
|
|
BETA HYDROXYBUTYRATE (Vitros)
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
2232274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$15.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$93.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Worker's Compensation |
$11.24
|
|
|
BETAMETH 45GM W/LUBRIDERM 1 PINT
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
3300103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$91.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Humana ChoiceCare |
$61.88
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.80
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$209.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.00
|
| Rate for Payer: Zelis Worker's Compensation |
$64.97
|
|
|
BETAMETH 45GM W/LUBRIDERM 1 PINT
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
3300103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$91.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$166.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Worker's Compensation |
$64.97
|
|
|
BETAMETHASONE CREAM 0.05%
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
NDC 45802037635
|
| Hospital Charge Code |
3300104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: First Health Workers Compensation |
$132.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$275.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Humana ChoiceCare |
$89.44
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$206.40
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$302.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.00
|
| Rate for Payer: Zelis Worker's Compensation |
$93.91
|
|
|
BETAMETHASONE CREAM 0.05%
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
NDC 45802037635
|
| Hospital Charge Code |
3300104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.91 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: First Health Workers Compensation |
$132.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
| Rate for Payer: Zelis Worker's Compensation |
$93.91
|
|
|
BETAMETHASONE DIP OINT 0.05% 15 GM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
NDC 68180094701
|
| Hospital Charge Code |
3303142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.75 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$183.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$380.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Humana ChoiceCare |
$123.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$285.00
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$418.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.50
|
| Rate for Payer: Zelis Worker's Compensation |
$129.68
|
|
|
BETAMETHASONE DIP OINT 0.05% 15 GM
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 68180094701
|
| Hospital Charge Code |
3303142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$183.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$332.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$129.68
|
|
|
BETHANECHOL 25MG TAB
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 65162057310
|
| Hospital Charge Code |
3305021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
BETHANECHOL 25MG TAB
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 65162057310
|
| Hospital Charge Code |
3305021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
BET NA PHOS ACE 6MG/ML INJ.
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
3300102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
BET NA PHOS ACE 6MG/ML INJ.
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
3300102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$7.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$6.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.00
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
BFBCK, PERIN, ANORCTL, URTHR ADDL 15 MIN
|
Facility
|
IP
|
$90.69
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
23590913
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Cash Price |
$54.41
|
| Rate for Payer: Cigna Commercial |
$77.09
|
| Rate for Payer: First Health Commercial |
$81.62
|
| Rate for Payer: First Health Workers Compensation |
$35.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.62
|
| Rate for Payer: GEHA Commercial |
$63.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.62
|
| Rate for Payer: Multiplan All |
$82.53
|
| Rate for Payer: OMNI Networks Commercial |
$63.48
|
| Rate for Payer: One Health Plan PPO/POS |
$81.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.16
|
| Rate for Payer: Three Rivers Provider Network All |
$68.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.34
|
| Rate for Payer: Zelis Auto |
$36.28
|
| Rate for Payer: Zelis Worker's Compensation |
$24.76
|
|
|
BFBCK, PERIN, ANORCTL, URTHR ADDL 15 MIN
|
Facility
|
OP
|
$90.69
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
23590913
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$68.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$68.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$54.02
|
| Rate for Payer: Cash Price |
$54.41
|
| Rate for Payer: Cash Price |
$54.41
|
| Rate for Payer: Cigna Commercial |
$77.09
|
| Rate for Payer: First Health Commercial |
$81.62
|
| Rate for Payer: First Health Workers Compensation |
$35.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.62
|
| Rate for Payer: GEHA Commercial |
$72.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.62
|
| Rate for Payer: Humana ChoiceCare |
$23.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$55.12
|
| Rate for Payer: Multiplan All |
$82.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.41
|
| Rate for Payer: OMNI Networks Commercial |
$63.48
|
| Rate for Payer: One Health Plan PPO/POS |
$81.62
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$63.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$55.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.16
|
| Rate for Payer: Three Rivers Provider Network All |
$68.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$79.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.34
|
| Rate for Payer: Zelis Auto |
$36.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.34
|
| Rate for Payer: Zelis Worker's Compensation |
$24.76
|
|
|
BFBK, PRINL, ANORCTL, URETHR INIT 15 MIN
|
Facility
|
IP
|
$220.53
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
23590912
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Cash Price |
$132.32
|
| Rate for Payer: Cigna Commercial |
$187.45
|
| Rate for Payer: First Health Commercial |
$198.48
|
| Rate for Payer: First Health Workers Compensation |
$85.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.48
|
| Rate for Payer: GEHA Commercial |
$154.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.48
|
| Rate for Payer: Multiplan All |
$200.68
|
| Rate for Payer: OMNI Networks Commercial |
$154.37
|
| Rate for Payer: One Health Plan PPO/POS |
$198.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.50
|
| Rate for Payer: Three Rivers Provider Network All |
$165.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.09
|
| Rate for Payer: Zelis Auto |
$88.21
|
| Rate for Payer: Zelis Worker's Compensation |
$60.20
|
|
|
BFBK, PRINL, ANORCTL, URETHR INIT 15 MIN
|
Facility
|
OP
|
$220.53
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
23590912
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.34 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.85
|
| Rate for Payer: Cash Price |
$132.32
|
| Rate for Payer: Cash Price |
$132.32
|
| Rate for Payer: Cigna Commercial |
$187.45
|
| Rate for Payer: First Health Commercial |
$198.48
|
| Rate for Payer: First Health Workers Compensation |
$85.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.48
|
| Rate for Payer: GEHA Commercial |
$176.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.48
|
| Rate for Payer: Humana ChoiceCare |
$57.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$136.58
|
| Rate for Payer: Multiplan All |
$200.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$132.32
|
| Rate for Payer: OMNI Networks Commercial |
$154.37
|
| Rate for Payer: One Health Plan PPO/POS |
$198.48
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$157.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$136.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.50
|
| Rate for Payer: Three Rivers Provider Network All |
$165.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$194.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.09
|
| Rate for Payer: Zelis Auto |
$88.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$110.27
|
| Rate for Payer: Zelis Worker's Compensation |
$60.20
|
|
|
BF CELL COUNT
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
2209051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.72
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$9.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$4.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$5.19
|
| Rate for Payer: Humana Medicare Advantage |
$4.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.72
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.02
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.44
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.63
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.72
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.66
|
| Rate for Payer: Zelis Worker's Compensation |
$6.54
|
|
|
BF CELL COUNT
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
2209051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$9.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6.54
|
|
|
BF cholesterol REF 247282
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2200687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$10.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.63
|
|
|
BF cholesterol REF 247282
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2200687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$10.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: GEHA Medicare |
$8.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$8.91
|
| Rate for Payer: Humana Medicare Advantage |
$8.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.10
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.77
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.20
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.94
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.10
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$6.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.72
|
| Rate for Payer: Zelis Worker's Compensation |
$7.63
|
|
|
BF CSF with DIFF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.60
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.52
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.20
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.60
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$4.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.72
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF CSF with DIFF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
2211111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.44
|
|
|
BF GLUCOSE (Vitros)
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
2232286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$93.10 |
| 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 |
$58.80
|
| 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 |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$7.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| 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 |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| 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 |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| 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 |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$4.98
|
|
|
BF GLUCOSE (Vitros)
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
2232286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$7.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.98
|
|
