|
rpr REF006460
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
2299163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$63.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
rpr REF006460
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
2299163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: GEHA Medicare |
$4.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$4.70
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.27
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.26
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.54
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.18
|
| Rate for Payer: United Healthcare Commercial |
$77.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.27
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Medicare |
$3.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.12
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
RPR REM HERNIA, INIT, REDUCE
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
6149550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$6,839.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$721.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,419.59
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cigna Commercial |
$1,022.55
|
| Rate for Payer: First Health Commercial |
$1,082.70
|
| Rate for Payer: First Health Workers Compensation |
$464.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,082.70
|
| Rate for Payer: GEHA Commercial |
$962.40
|
| Rate for Payer: GEHA Medicare |
$3,419.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,082.70
|
| Rate for Payer: Humana ChoiceCare |
$3,761.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,419.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,744.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,419.59
|
| Rate for Payer: Multiplan All |
$1,094.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,813.30
|
| Rate for Payer: OMNI Networks Commercial |
$842.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,082.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,419.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,142.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,839.18
|
| Rate for Payer: Three Rivers Provider Network All |
$902.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,351.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,118.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,419.59
|
| Rate for Payer: Zelis Auto |
$481.20
|
| Rate for Payer: Zelis Medicare |
$2,906.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,103.51
|
| Rate for Payer: Zelis Worker's Compensation |
$328.42
|
|
|
RPR REM HERNIA, INIT, REDUCE
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
6149550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$1,142.85 |
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cigna Commercial |
$1,022.55
|
| Rate for Payer: First Health Commercial |
$1,082.70
|
| Rate for Payer: First Health Workers Compensation |
$464.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,082.70
|
| Rate for Payer: GEHA Commercial |
$842.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,082.70
|
| Rate for Payer: Multiplan All |
$1,094.73
|
| Rate for Payer: OMNI Networks Commercial |
$842.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,082.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,142.85
|
| Rate for Payer: Three Rivers Provider Network All |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,118.79
|
| Rate for Payer: Zelis Auto |
$481.20
|
| Rate for Payer: Zelis Worker's Compensation |
$328.42
|
|
|
RPR S/N/AX/GEN/TRNK >30.0 CM
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
6112007
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$323.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
RPR S/N/AX/GEN/TRNK >30.0 CM
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
6112007
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PO
|
Facility
|
OP
|
$2,509.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
1936575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.22 |
| Max. Negotiated Rate |
$2,383.55 |
| 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 |
$1,505.40
|
| 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 |
$599.08
|
| Rate for Payer: Cash Price |
$1,505.40
|
| Rate for Payer: Cash Price |
$1,505.40
|
| Rate for Payer: Cigna Commercial |
$2,132.65
|
| Rate for Payer: First Health Commercial |
$2,258.10
|
| Rate for Payer: First Health Workers Compensation |
$968.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,258.10
|
| Rate for Payer: GEHA Commercial |
$2,007.20
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,258.10
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$2,283.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,756.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,258.10
|
| 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 |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,383.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,881.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,333.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$1,003.60
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$684.96
|
|
|
RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PO
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
6136575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PO
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
6136575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$1,198.16 |
| 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 |
$66.60
|
| 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 |
$599.08
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| 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 |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PO
|
Facility
|
IP
|
$2,509.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
1936575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.96 |
| Max. Negotiated Rate |
$2,383.55 |
| Rate for Payer: Cash Price |
$1,505.40
|
| Rate for Payer: Cigna Commercial |
$2,132.65
|
| Rate for Payer: First Health Commercial |
$2,258.10
|
| Rate for Payer: First Health Workers Compensation |
$968.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,258.10
|
| Rate for Payer: GEHA Commercial |
$1,756.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,258.10
|
| Rate for Payer: Multiplan All |
$2,283.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,756.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,258.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,383.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,881.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,333.37
|
| Rate for Payer: Zelis Auto |
$1,003.60
|
| Rate for Payer: Zelis Worker's Compensation |
$684.96
|
|
|
RPR UMBIL HERN, BLOCK < 5 YR
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 49582
|
| Hospital Charge Code |
6149582
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.75 |
| Max. Negotiated Rate |
$956.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$604.20
|
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: First Health Commercial |
$906.30
|
| Rate for Payer: First Health Workers Compensation |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$906.30
|
| Rate for Payer: GEHA Commercial |
$805.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$906.30
|
| Rate for Payer: Humana ChoiceCare |
$261.82
|
| Rate for Payer: Multiplan All |
$916.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$604.20
|
| Rate for Payer: OMNI Networks Commercial |
$704.90
|
| Rate for Payer: One Health Plan PPO/POS |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$956.65
|
| Rate for Payer: Three Rivers Provider Network All |
$755.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$886.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$251.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$936.51
|
| Rate for Payer: Zelis Auto |
$402.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$503.50
|
| Rate for Payer: Zelis Worker's Compensation |
$274.91
|
|
|
RPR UMBIL HERN, BLOCK < 5 YR
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 49582
|
| Hospital Charge Code |
6149582
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.91 |
| Max. Negotiated Rate |
$956.65 |
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: First Health Commercial |
$906.30
|
| Rate for Payer: First Health Workers Compensation |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$906.30
|
| Rate for Payer: GEHA Commercial |
$704.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$906.30
|
| Rate for Payer: Multiplan All |
$916.37
|
| Rate for Payer: OMNI Networks Commercial |
$704.90
|
| Rate for Payer: One Health Plan PPO/POS |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$956.65
|
| Rate for Payer: Three Rivers Provider Network All |
$755.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$936.51
|
| Rate for Payer: Zelis Auto |
$402.80
|
| Rate for Payer: Zelis Worker's Compensation |
$274.91
|
|
|
RPR UMBIL HERN, BLOCK > 5 YR
|
Facility
|
IP
|
$1,511.00
|
|
|
Service Code
|
CPT 49587
|
| Hospital Charge Code |
6149587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,435.45 |
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$1,284.35
|
| Rate for Payer: First Health Commercial |
$1,359.90
|
| Rate for Payer: First Health Workers Compensation |
$583.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,359.90
|
| Rate for Payer: GEHA Commercial |
$1,057.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,359.90
|
| Rate for Payer: Multiplan All |
$1,375.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,057.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,359.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,435.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,133.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,405.23
|
| Rate for Payer: Zelis Auto |
$604.40
|
| Rate for Payer: Zelis Worker's Compensation |
$412.50
|
|
|
RPR UMBIL HERN, BLOCK > 5 YR
|
Facility
|
OP
|
$1,511.00
|
|
|
Service Code
|
CPT 49587
|
| Hospital Charge Code |
6149587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.75 |
| Max. Negotiated Rate |
$1,435.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$906.60
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$1,284.35
|
| Rate for Payer: First Health Commercial |
$1,359.90
|
| Rate for Payer: First Health Workers Compensation |
$583.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,359.90
|
| Rate for Payer: GEHA Commercial |
$1,208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,359.90
|
| Rate for Payer: Humana ChoiceCare |
$392.86
|
| Rate for Payer: Multiplan All |
$1,375.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$906.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,057.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,359.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,435.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,133.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,329.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$377.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,405.23
|
| Rate for Payer: Zelis Auto |
$604.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$755.50
|
| Rate for Payer: Zelis Worker's Compensation |
$412.50
|
|
|
RPR UMBIL HERN, REDUC < 5 YR
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT 49580
|
| Hospital Charge Code |
6149580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$688.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Humana ChoiceCare |
$223.60
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$516.00
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$756.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$215.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
RPR UMBIL HERN, REDUC < 5 YR
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 49580
|
| Hospital Charge Code |
6149580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$602.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
RPR UMBIL HERN, REDUC > 5 YR
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
6149585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$385.75 |
| Max. Negotiated Rate |
$1,342.35 |
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$1,201.05
|
| Rate for Payer: First Health Commercial |
$1,271.70
|
| Rate for Payer: First Health Workers Compensation |
$545.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,271.70
|
| Rate for Payer: GEHA Commercial |
$989.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,271.70
|
| Rate for Payer: Multiplan All |
$1,285.83
|
| Rate for Payer: OMNI Networks Commercial |
$989.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,271.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,342.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,314.09
|
| Rate for Payer: Zelis Auto |
$565.20
|
| Rate for Payer: Zelis Worker's Compensation |
$385.75
|
|
|
RPR UMBIL HERN, REDUC > 5 YR
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
6149585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.25 |
| Max. Negotiated Rate |
$1,342.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$847.80
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$1,201.05
|
| Rate for Payer: First Health Commercial |
$1,271.70
|
| Rate for Payer: First Health Workers Compensation |
$545.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,271.70
|
| Rate for Payer: GEHA Commercial |
$1,130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,271.70
|
| Rate for Payer: Humana ChoiceCare |
$367.38
|
| Rate for Payer: Multiplan All |
$1,285.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$847.80
|
| Rate for Payer: OMNI Networks Commercial |
$989.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,271.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,342.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,243.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,314.09
|
| Rate for Payer: Zelis Auto |
$565.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$706.50
|
| Rate for Payer: Zelis Worker's Compensation |
$385.75
|
|
|
RPR VENTRAL HERN INIT, BLOCK
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
6149561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$1,661.75
|
| Rate for Payer: First Health Commercial |
$1,759.50
|
| Rate for Payer: First Health Workers Compensation |
$754.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,759.50
|
| Rate for Payer: GEHA Commercial |
$1,368.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,759.50
|
| Rate for Payer: Multiplan All |
$1,779.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,368.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,759.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,857.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,466.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,818.15
|
| Rate for Payer: Zelis Auto |
$782.00
|
| Rate for Payer: Zelis Worker's Compensation |
$533.72
|
|
|
RPR VENTRAL HERN INIT, BLOCK
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
6149561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.75 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$1,661.75
|
| Rate for Payer: First Health Commercial |
$1,759.50
|
| Rate for Payer: First Health Workers Compensation |
$754.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,759.50
|
| Rate for Payer: GEHA Commercial |
$1,564.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,759.50
|
| Rate for Payer: Humana ChoiceCare |
$508.30
|
| Rate for Payer: Multiplan All |
$1,779.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,173.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,368.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,759.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,857.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,466.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,720.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$488.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,818.15
|
| Rate for Payer: Zelis Auto |
$782.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$977.50
|
| Rate for Payer: Zelis Worker's Compensation |
$533.72
|
|
|
RPR VENTRAL HERN INIT, REDUC
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 49560
|
| Hospital Charge Code |
6149560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.06 |
| Max. Negotiated Rate |
$1,468.70 |
| Rate for Payer: Cash Price |
$927.60
|
| Rate for Payer: Cigna Commercial |
$1,314.10
|
| Rate for Payer: First Health Commercial |
$1,391.40
|
| Rate for Payer: First Health Workers Compensation |
$596.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,391.40
|
| Rate for Payer: GEHA Commercial |
$1,082.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,391.40
|
| Rate for Payer: Multiplan All |
$1,406.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,391.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,468.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,159.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,437.78
|
| Rate for Payer: Zelis Auto |
$618.40
|
| Rate for Payer: Zelis Worker's Compensation |
$422.06
|
|
|
RPR VENTRAL HERN INIT, REDUC
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 49560
|
| Hospital Charge Code |
6149560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.50 |
| Max. Negotiated Rate |
$1,468.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$927.60
|
| Rate for Payer: Cash Price |
$927.60
|
| Rate for Payer: Cigna Commercial |
$1,314.10
|
| Rate for Payer: First Health Commercial |
$1,391.40
|
| Rate for Payer: First Health Workers Compensation |
$596.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,391.40
|
| Rate for Payer: GEHA Commercial |
$1,236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,391.40
|
| Rate for Payer: Humana ChoiceCare |
$401.96
|
| Rate for Payer: Multiplan All |
$1,406.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$927.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,391.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,468.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,159.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,360.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$386.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,437.78
|
| Rate for Payer: Zelis Auto |
$618.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$773.00
|
| Rate for Payer: Zelis Worker's Compensation |
$422.06
|
|
|
RPR XTNSR FING W/O GRAF
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
8126605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$397.21 |
| Max. Negotiated Rate |
$1,382.25 |
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna Commercial |
$1,236.75
|
| Rate for Payer: First Health Commercial |
$1,309.50
|
| Rate for Payer: First Health Workers Compensation |
$561.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,309.50
|
| Rate for Payer: GEHA Commercial |
$1,018.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,309.50
|
| Rate for Payer: Multiplan All |
$1,324.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,018.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,309.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,382.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,091.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,353.15
|
| Rate for Payer: Zelis Auto |
$582.00
|
| Rate for Payer: Zelis Worker's Compensation |
$397.21
|
|
|
RPR XTNSR FING W/O GRAF
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
8126605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.75 |
| Max. Negotiated Rate |
$1,382.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna Commercial |
$1,236.75
|
| Rate for Payer: First Health Commercial |
$1,309.50
|
| Rate for Payer: First Health Workers Compensation |
$561.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,309.50
|
| Rate for Payer: GEHA Commercial |
$1,164.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,309.50
|
| Rate for Payer: Humana ChoiceCare |
$378.30
|
| Rate for Payer: Multiplan All |
$1,324.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$873.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,018.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,309.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,382.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,280.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$363.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,353.15
|
| Rate for Payer: Zelis Auto |
$582.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$727.50
|
| Rate for Payer: Zelis Worker's Compensation |
$397.21
|
|
|
RSECT HIP TUM INCL FEMUR
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 27078
|
| Hospital Charge Code |
6127078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,071.25 |
| Max. Negotiated Rate |
$4,070.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,571.00
|
| Rate for Payer: Cash Price |
$2,571.00
|
| Rate for Payer: Cigna Commercial |
$3,642.25
|
| Rate for Payer: First Health Commercial |
$3,856.50
|
| Rate for Payer: First Health Workers Compensation |
$1,654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,856.50
|
| Rate for Payer: GEHA Commercial |
$3,428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,856.50
|
| Rate for Payer: Humana ChoiceCare |
$1,114.10
|
| Rate for Payer: Multiplan All |
$3,899.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,571.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,999.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,856.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,070.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,770.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,071.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,985.05
|
| Rate for Payer: Zelis Auto |
$1,714.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,142.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,169.81
|
|
