|
REPEAT SODIUM SERUM
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
2299901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$8.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$58.40
|
| Rate for Payer: GEHA Medicare |
$4.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Humana ChoiceCare |
$5.29
|
| Rate for Payer: Humana Medicare Advantage |
$4.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.81
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.18
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.62
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.71
|
| Rate for Payer: United Healthcare Commercial |
$62.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.81
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Medicare |
$4.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.77
|
| Rate for Payer: Zelis Worker's Compensation |
$6.08
|
|
|
REPEAT SODIUM SERUM
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
2299901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$8.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$51.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.08
|
|
|
REPEAT THYROID SURGERY
|
Facility
|
IP
|
$2,283.00
|
|
|
Service Code
|
CPT 60260
|
| Hospital Charge Code |
6160260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$623.26 |
| Max. Negotiated Rate |
$2,168.85 |
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: First Health Workers Compensation |
$881.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,598.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: Zelis Auto |
$913.20
|
| Rate for Payer: Zelis Worker's Compensation |
$623.26
|
|
|
REPEAT THYROID SURGERY
|
Facility
|
OP
|
$2,283.00
|
|
|
Service Code
|
CPT 60260
|
| Hospital Charge Code |
6160260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$623.26 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,369.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: First Health Workers Compensation |
$881.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,826.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$913.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$623.26
|
|
|
REPET TMS TX INITIAL W/MAP/MOTR THRESHLD
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 90867
|
| Hospital Charge Code |
9599241
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$161.89 |
| Max. Negotiated Rate |
$563.35 |
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$504.05
|
| Rate for Payer: First Health Commercial |
$533.70
|
| Rate for Payer: First Health Workers Compensation |
$228.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$533.70
|
| Rate for Payer: GEHA Commercial |
$415.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$533.70
|
| Rate for Payer: Multiplan All |
$539.63
|
| Rate for Payer: OMNI Networks Commercial |
$415.10
|
| Rate for Payer: One Health Plan PPO/POS |
$533.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$563.35
|
| Rate for Payer: Three Rivers Provider Network All |
$444.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$551.49
|
| Rate for Payer: Zelis Auto |
$237.20
|
| Rate for Payer: Zelis Worker's Compensation |
$161.89
|
|
|
REPET TMS TX INITIAL W/MAP/MOTR THRESHLD
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 90867
|
| Hospital Charge Code |
9599241
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$161.89 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$273.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$355.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$273.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$216.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$504.05
|
| Rate for Payer: First Health Commercial |
$533.70
|
| Rate for Payer: First Health Workers Compensation |
$228.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$533.70
|
| Rate for Payer: GEHA Commercial |
$474.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$533.70
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$220.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$539.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$415.10
|
| Rate for Payer: One Health Plan PPO/POS |
$533.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$255.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$220.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$563.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$444.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$551.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$237.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$161.89
|
|
|
REPLACE AORTIC VALVE W/BYP
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
CPT 33369
|
| Hospital Charge Code |
6133369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.39 |
| Max. Negotiated Rate |
$2,009.25 |
| Rate for Payer: Cash Price |
$1,269.00
|
| Rate for Payer: Cigna Commercial |
$1,797.75
|
| Rate for Payer: First Health Commercial |
$1,903.50
|
| Rate for Payer: First Health Workers Compensation |
$816.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,903.50
|
| Rate for Payer: GEHA Commercial |
$1,480.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,903.50
|
| Rate for Payer: Multiplan All |
$1,924.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,480.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,903.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,009.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,586.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,966.95
|
| Rate for Payer: Zelis Auto |
$846.00
|
| Rate for Payer: Zelis Worker's Compensation |
$577.39
|
|
|
REPLACE AORTIC VALVE W/BYP
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
CPT 33369
|
| Hospital Charge Code |
6133369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$528.75 |
| Max. Negotiated Rate |
$2,009.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,269.00
|
| Rate for Payer: Cash Price |
$1,269.00
|
| Rate for Payer: Cigna Commercial |
$1,797.75
|
| Rate for Payer: First Health Commercial |
$1,903.50
|
| Rate for Payer: First Health Workers Compensation |
$816.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,903.50
|
| Rate for Payer: GEHA Commercial |
$1,692.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,903.50
|
| Rate for Payer: Humana ChoiceCare |
$549.90
|
| Rate for Payer: Multiplan All |
$1,924.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,269.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,480.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,903.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,009.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,586.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,861.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$528.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,966.95
|
| Rate for Payer: Zelis Auto |
$846.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,057.50
|
| Rate for Payer: Zelis Worker's Compensation |
$577.39
|
|
|
REPLACE ELBOW JOINT
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT 24363
|
| Hospital Charge Code |
6124363
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$819.82 |
| Max. Negotiated Rate |
$2,852.85 |
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cigna Commercial |
$2,552.55
|
| Rate for Payer: First Health Commercial |
$2,702.70
|
| Rate for Payer: First Health Workers Compensation |
$1,159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,702.70
|
| Rate for Payer: GEHA Commercial |
$2,102.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,702.70
|
| Rate for Payer: Multiplan All |
$2,732.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,102.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,702.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,852.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,252.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,792.79
|
| Rate for Payer: Zelis Auto |
$1,201.20
|
| Rate for Payer: Zelis Worker's Compensation |
$819.82
|
|
|
REPLACE ELBOW JOINT
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT 24363
|
| Hospital Charge Code |
6124363
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$819.82 |
| Max. Negotiated Rate |
$34,924.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,801.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,513.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,462.09
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cigna Commercial |
$2,552.55
|
| Rate for Payer: First Health Commercial |
$2,702.70
|
| Rate for Payer: First Health Workers Compensation |
$1,159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,702.70
|
| Rate for Payer: GEHA Commercial |
$2,402.40
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,702.70
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$2,732.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,102.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,702.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11,207.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,706.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,852.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,252.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,792.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$1,201.20
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$819.82
|
|
|
REPLACE G/C TUBE PERC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
6149450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$81.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$147.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Worker's Compensation |
$57.33
|
|
|
REPLACE G/C TUBE PERC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
6149450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$510.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$81.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$601.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$520.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$57.33
|
|
|
REPLACEMENT FACEMASK INTERFA
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT A7031
|
| Hospital Charge Code |
3000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: First Health Workers Compensation |
$38.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.03
|
|
|
REPLACEMENT FACEMASK INTERFA
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT A7031
|
| Hospital Charge Code |
3000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: First Health Workers Compensation |
$38.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$25.74
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.40
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.50
|
| Rate for Payer: Zelis Worker's Compensation |
$27.03
|
|
|
REPLACEMENT NASAL CUSHION
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
3000015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$21.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$15.29
|
|
|
REPLACEMENT NASAL CUSHION
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
3000015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$21.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.60
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.29
|
|
|
REPLACEMENT NASAL PILLOWS
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT A7033
|
| Hospital Charge Code |
3000016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$32.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
REPLACEMENT NASAL PILLOWS
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT A7033
|
| Hospital Charge Code |
3000016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$36.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$11.96
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.60
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
REPLACE PICC LINE
|
Facility
|
IP
|
$1,729.00
|
|
| Hospital Charge Code |
2410003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.02 |
| Max. Negotiated Rate |
$1,642.55 |
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: First Health Workers Compensation |
$667.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,556.10
|
| Rate for Payer: GEHA Commercial |
$1,210.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,556.10
|
| Rate for Payer: Multiplan All |
$1,573.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,210.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,642.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.97
|
| Rate for Payer: Zelis Auto |
$691.60
|
| Rate for Payer: Zelis Worker's Compensation |
$472.02
|
|
|
REPLACE PICC LINE
|
Facility
|
OP
|
$1,729.00
|
|
| Hospital Charge Code |
2410003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$1,642.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: First Health Workers Compensation |
$667.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,556.10
|
| Rate for Payer: GEHA Commercial |
$1,383.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,556.10
|
| Rate for Payer: Humana ChoiceCare |
$449.54
|
| Rate for Payer: Multiplan All |
$1,573.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,037.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,210.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,642.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,521.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$432.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.97
|
| Rate for Payer: Zelis Auto |
$691.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$864.50
|
| Rate for Payer: Zelis Worker's Compensation |
$472.02
|
|
|
REPLACE SKULL PLATE/FLAP
|
Facility
|
OP
|
$2,216.00
|
|
|
Service Code
|
CPT 62143
|
| Hospital Charge Code |
6162143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$554.00 |
| Max. Negotiated Rate |
$2,105.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cigna Commercial |
$1,883.60
|
| Rate for Payer: First Health Commercial |
$1,994.40
|
| Rate for Payer: First Health Workers Compensation |
$855.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,994.40
|
| Rate for Payer: GEHA Commercial |
$1,772.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,994.40
|
| Rate for Payer: Humana ChoiceCare |
$576.16
|
| Rate for Payer: Multiplan All |
$2,016.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,329.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,551.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,994.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,105.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,662.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,950.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$554.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,060.88
|
| Rate for Payer: Zelis Auto |
$886.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,108.00
|
| Rate for Payer: Zelis Worker's Compensation |
$604.97
|
|
|
REPLACE SKULL PLATE/FLAP
|
Facility
|
IP
|
$2,216.00
|
|
|
Service Code
|
CPT 62143
|
| Hospital Charge Code |
6162143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.97 |
| Max. Negotiated Rate |
$2,105.20 |
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cigna Commercial |
$1,883.60
|
| Rate for Payer: First Health Commercial |
$1,994.40
|
| Rate for Payer: First Health Workers Compensation |
$855.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,994.40
|
| Rate for Payer: GEHA Commercial |
$1,551.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,994.40
|
| Rate for Payer: Multiplan All |
$2,016.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,551.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,994.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,105.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,662.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,060.88
|
| Rate for Payer: Zelis Auto |
$886.40
|
| Rate for Payer: Zelis Worker's Compensation |
$604.97
|
|
|
REPLACE URETER BY BOWEL
|
Facility
|
IP
|
$2,544.00
|
|
|
Service Code
|
CPT 50840
|
| Hospital Charge Code |
6150840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$694.51 |
| Max. Negotiated Rate |
$2,416.80 |
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Cigna Commercial |
$2,162.40
|
| Rate for Payer: First Health Commercial |
$2,289.60
|
| Rate for Payer: First Health Workers Compensation |
$982.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,289.60
|
| Rate for Payer: GEHA Commercial |
$1,780.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,289.60
|
| Rate for Payer: Multiplan All |
$2,315.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,780.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,289.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,416.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,365.92
|
| Rate for Payer: Zelis Auto |
$1,017.60
|
| Rate for Payer: Zelis Worker's Compensation |
$694.51
|
|
|
REPLACE URETER BY BOWEL
|
Facility
|
OP
|
$2,544.00
|
|
|
Service Code
|
CPT 50840
|
| Hospital Charge Code |
6150840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,416.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,526.40
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Cigna Commercial |
$2,162.40
|
| Rate for Payer: First Health Commercial |
$2,289.60
|
| Rate for Payer: First Health Workers Compensation |
$982.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,289.60
|
| Rate for Payer: GEHA Commercial |
$2,035.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,289.60
|
| Rate for Payer: Humana ChoiceCare |
$661.44
|
| Rate for Payer: Multiplan All |
$2,315.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,526.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,780.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,289.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,416.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,238.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$636.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,365.92
|
| Rate for Payer: Zelis Auto |
$1,017.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,272.00
|
| Rate for Payer: Zelis Worker's Compensation |
$694.51
|
|
|
REPLACE VAD INTRA W/BP
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 33983
|
| Hospital Charge Code |
6133983
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,241.25 |
| Max. Negotiated Rate |
$4,716.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$4,220.25
|
| Rate for Payer: First Health Commercial |
$4,468.50
|
| Rate for Payer: First Health Workers Compensation |
$1,916.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,468.50
|
| Rate for Payer: GEHA Commercial |
$3,972.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,468.50
|
| Rate for Payer: Humana ChoiceCare |
$1,290.90
|
| Rate for Payer: Multiplan All |
$4,518.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,979.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,475.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,468.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,716.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,723.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,369.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,241.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,617.45
|
| Rate for Payer: Zelis Auto |
$1,986.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,482.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,355.44
|
|
