|
ROPIVACAINE 0.5% 100MG/20ML VIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3302580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$20.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$0.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Humana ChoiceCare |
$13.52
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.20
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
ROPIVACAINE 0.5% 100MG/20ML VIAL
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3302580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$20.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$36.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
ROPIVACAINE 0.5% 150MG/30ML VIAL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3301959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$0.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Humana ChoiceCare |
$15.60
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.00
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$52.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
ROPIVACAINE 0.5% 150MG/30ML VIAL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3301959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$42.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
ROPIVACAINE HCL INJ 2MG/ML
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3300808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
ROPIVACAINE HCL INJ 2MG/ML
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3300808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: First Health Workers Compensation |
$15.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$0.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Humana ChoiceCare |
$10.40
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.00
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.92
|
|
|
rotavirus antigen REF006866
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
2299415
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: GEHA Medicare |
$11.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$13.18
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.98
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.37
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.96
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.98
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Medicare |
$10.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.38
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
rotavirus antigen REF006866
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
2299415
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
ROTOVIRUS VACC 3 DOSE, OR
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
8590680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
ROTOVIRUS VACC 3 DOSE, OR
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
8590680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$42.12
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.20
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.00
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
rough pigweed IgE REF602484
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$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 |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
rough pigweed IgE REF602484
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$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 |
$11.22
|
| 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 |
$7.93
|
|
|
ROUTINE FT CARE PHYS DIAB PT W/LOPS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT G0247
|
| Hospital Charge Code |
8500247
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
ROUTINE FT CARE PHYS DIAB PT W/LOPS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT G0247
|
| Hospital Charge Code |
8700247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
ROUTINE FT CARE PHYS DIAB PT W/LOPS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT G0247
|
| Hospital Charge Code |
9600247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
ROUTINE FT CARE PHYS DIAB PT W/LOPS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT G0247
|
| Hospital Charge Code |
9600247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
ROUTINE FT CARE PHYS DIAB PT W/LOPS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT G0247
|
| Hospital Charge Code |
8500247
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
ROUTINE FT CARE PHYS DIAB PT W/LOPS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT G0247
|
| Hospital Charge Code |
8700247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
RP CMPX SCLP/ARMS/LEGS 1.1\2.5
|
Facility
|
IP
|
$1,491.00
|
|
| Hospital Charge Code |
8150023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.04 |
| Max. Negotiated Rate |
$1,416.45 |
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna Commercial |
$1,267.35
|
| Rate for Payer: First Health Commercial |
$1,341.90
|
| Rate for Payer: First Health Workers Compensation |
$575.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.90
|
| Rate for Payer: GEHA Commercial |
$1,043.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.90
|
| Rate for Payer: Multiplan All |
$1,356.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,416.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,118.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,386.63
|
| Rate for Payer: Zelis Auto |
$596.40
|
| Rate for Payer: Zelis Worker's Compensation |
$407.04
|
|
|
RP CMPX SCLP/ARMS/LEGS 1.1\2.5
|
Facility
|
OP
|
$1,491.00
|
|
| Hospital Charge Code |
8150023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,416.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna Commercial |
$1,267.35
|
| Rate for Payer: First Health Commercial |
$1,341.90
|
| Rate for Payer: First Health Workers Compensation |
$575.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.90
|
| Rate for Payer: GEHA Commercial |
$1,192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.90
|
| Rate for Payer: Humana ChoiceCare |
$387.66
|
| Rate for Payer: Multiplan All |
$1,356.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$894.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,416.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,118.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,312.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,386.63
|
| Rate for Payer: Zelis Auto |
$596.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$745.50
|
| Rate for Payer: Zelis Worker's Compensation |
$407.04
|
|
|
RP CMX SCLP/ARMS/LEGS EA AD 5C
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
8150025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
RP CMX SCLP/ARMS/LEGS EA AD 5C
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
8150025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Humana ChoiceCare |
$131.04
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$302.40
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$443.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$252.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
6136582
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$782.00
|
| Rate for Payer: First Health Commercial |
$828.00
|
| Rate for Payer: First Health Workers Compensation |
$355.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.00
|
| Rate for Payer: GEHA Commercial |
$644.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.00
|
| Rate for Payer: Multiplan All |
$837.20
|
| Rate for Payer: OMNI Networks Commercial |
$644.00
|
| Rate for Payer: One Health Plan PPO/POS |
$828.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.00
|
| Rate for Payer: Three Rivers Provider Network All |
$690.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$855.60
|
| Rate for Payer: Zelis Auto |
$368.00
|
| Rate for Payer: Zelis Worker's Compensation |
$251.16
|
|
|
RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
6136582
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$782.00
|
| Rate for Payer: First Health Commercial |
$828.00
|
| Rate for Payer: First Health Workers Compensation |
$355.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.00
|
| Rate for Payer: GEHA Commercial |
$736.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.00
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$837.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$644.00
|
| Rate for Payer: One Health Plan PPO/POS |
$828.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$690.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$855.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$368.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$251.16
|
|
|
RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGUL
|
Facility
|
IP
|
$3,026.85
|
|
|
Service Code
|
CPT 49596
|
| Hospital Charge Code |
6149596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$826.33 |
| Max. Negotiated Rate |
$2,875.51 |
| Rate for Payer: Cash Price |
$1,816.11
|
| Rate for Payer: Cigna Commercial |
$2,572.82
|
| Rate for Payer: First Health Commercial |
$2,724.16
|
| Rate for Payer: First Health Workers Compensation |
$1,168.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,724.16
|
| Rate for Payer: GEHA Commercial |
$2,118.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,724.16
|
| Rate for Payer: Multiplan All |
$2,754.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,118.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,724.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,875.51
|
| Rate for Payer: Three Rivers Provider Network All |
$2,270.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,814.97
|
| Rate for Payer: Zelis Auto |
$1,210.74
|
| Rate for Payer: Zelis Worker's Compensation |
$826.33
|
|
