|
SPECIAL CARE OBSERVATION EACH ADDL HOUR
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
9400087
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.61
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.29
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.60
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
SPECIAL CARE OBSERVATION EACH ADDL HOUR
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
9400087
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
SPECIAL CARE OBSERVATION INITIAL HOUR
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
9400086
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
SPECIAL CARE OBSERVATION INITIAL HOUR
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
9400086
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.61
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: First Health Workers Compensation |
$198.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Humana ChoiceCare |
$133.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.29
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$307.80
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$451.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$256.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.05
|
|
|
SPECIAL CARE UNIT
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
31111002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: First Health Commercial |
$2,250.00
|
| Rate for Payer: First Health Workers Compensation |
$965.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,250.00
|
| Rate for Payer: GEHA Commercial |
$1,750.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,250.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$2,275.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,750.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,250.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,375.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,875.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,325.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$1,000.00
|
| Rate for Payer: Zelis Worker's Compensation |
$682.50
|
|
|
SPECIAL CARE W ISOLATION
|
Facility
|
IP
|
$2,800.00
|
|
| Hospital Charge Code |
31110002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cigna Commercial |
$2,380.00
|
| Rate for Payer: First Health Commercial |
$2,520.00
|
| Rate for Payer: First Health Workers Compensation |
$1,081.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,520.00
|
| Rate for Payer: GEHA Commercial |
$1,960.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,520.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$2,548.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,960.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,520.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,660.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,100.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,604.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$1,120.00
|
| Rate for Payer: Zelis Worker's Compensation |
$764.40
|
|
|
SPECIAL CARE W ISO/TELE
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
31110002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$3,657.50 |
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,272.50
|
| Rate for Payer: First Health Commercial |
$3,465.00
|
| Rate for Payer: First Health Workers Compensation |
$1,486.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,465.00
|
| Rate for Payer: GEHA Commercial |
$2,695.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,465.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$3,503.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,695.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,465.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,657.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,887.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,580.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$1,540.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,051.05
|
|
|
SPECIAL CARE W TELEMETRY
|
Facility
|
IP
|
$3,100.00
|
|
| Hospital Charge Code |
31110002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$2,945.00 |
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cigna Commercial |
$2,635.00
|
| Rate for Payer: First Health Commercial |
$2,790.00
|
| Rate for Payer: First Health Workers Compensation |
$1,196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,790.00
|
| Rate for Payer: GEHA Commercial |
$2,170.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,790.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$2,821.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,170.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,790.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,945.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,325.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,883.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$1,240.00
|
| Rate for Payer: Zelis Worker's Compensation |
$846.30
|
|
|
SPECIAL CASTING MATERIAL
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
7204590
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: First Health Workers Compensation |
$72.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Humana ChoiceCare |
$49.14
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$113.40
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$166.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.50
|
| Rate for Payer: Zelis Worker's Compensation |
$51.60
|
|
|
SPECIAL CASTING MATERIAL
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
7204590
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: First Health Workers Compensation |
$72.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Worker's Compensation |
$51.60
|
|
|
SPECIAL CASTING MATERIAL
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
8504590
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: First Health Workers Compensation |
$72.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Worker's Compensation |
$51.60
|
|
|
SPECIAL CASTING MATERIAL
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
8504590
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: First Health Workers Compensation |
$72.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Humana ChoiceCare |
$49.14
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$113.40
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$166.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.50
|
| Rate for Payer: Zelis Worker's Compensation |
$51.60
|
|
|
SPECIAL STAINED SPECIMEN SLIDES TO EXAMI
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
2288341
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$103.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Commercial |
$181.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.09
|
|
|
SPECIAL STAINED SPECIMEN SLIDES TO EXAMI
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
2288341
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$103.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$73.09
|
|
|
SPECIALTY STAIN GROUP I
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
2299046
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$50.73
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$128.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$50.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$55.80
|
| Rate for Payer: Humana Medicare Advantage |
$50.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$114.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$50.73
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.24
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$114.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$101.46
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.72
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$50.73
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$43.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.88
|
| Rate for Payer: Zelis Worker's Compensation |
$90.97
|
|
|
SPECIALTY STAIN GROUP I
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
2299046
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$128.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$90.97
|
|
|
SPECIALTY STAIN GROUP II EACH
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2299047
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$115.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$115.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$93.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$93.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$107.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$93.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$168.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$66.01
|
|
|
SPECIALTY STAIN GROUP II EACH
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2299047
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$93.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$66.01
|
|
|
SPHENOID SINUS SURGERY
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT 31051
|
| Hospital Charge Code |
6131051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.81 |
| 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 |
$777.60
|
| 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 |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: First Health Commercial |
$1,166.40
|
| Rate for Payer: First Health Workers Compensation |
$500.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,166.40
|
| Rate for Payer: GEHA Commercial |
$1,036.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,166.40
|
| 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 |
$1,179.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$907.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,166.40
|
| 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 |
$1,231.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$972.00
|
| 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 |
$1,205.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$518.40
|
| 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 |
$353.81
|
|
|
SPHENOID SINUS SURGERY
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT 31051
|
| Hospital Charge Code |
6131051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.81 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: First Health Commercial |
$1,166.40
|
| Rate for Payer: First Health Workers Compensation |
$500.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,166.40
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,166.40
|
| Rate for Payer: Multiplan All |
$1,179.36
|
| Rate for Payer: OMNI Networks Commercial |
$907.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,166.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,231.20
|
| Rate for Payer: Three Rivers Provider Network All |
$972.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,205.28
|
| Rate for Payer: Zelis Auto |
$518.40
|
| Rate for Payer: Zelis Worker's Compensation |
$353.81
|
|
|
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,213.41 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$2,369.65
|
|
|
SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,919.98 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$2,369.65
|
|
|
SPIKED WASHER FOR CANCELLOUS SCREW
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
SPIKED WASHER FOR CANCELLOUS SCREW
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
SPIKED WASHER FOR CANCELLOUS SCREW
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
