|
TAPENTADOL (NUCYNTA) 100MG
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 24510011660
|
| Hospital Charge Code |
3302408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$34.32
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.20
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$116.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
TAPENTADOL (NUCYNTA) 50MG
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
NDC 24510005860
|
| Hospital Charge Code |
3302409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$23.66
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$80.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
TAPENTADOL (NUCYNTA) 50MG
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
NDC 24510005860
|
| Hospital Charge Code |
3302409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$86.45 |
| 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 |
$35.14
|
| 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 |
$24.84
|
|
|
targeted genomic seq analys
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
2200748
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$606.95 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: First Health Workers Compensation |
$858.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$2,633.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
| Rate for Payer: Zelis Worker's Compensation |
$606.95
|
|
|
targeted genomic seq analys
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
2200748
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$606.95 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,139.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,257.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,139.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$902.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: First Health Workers Compensation |
$858.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$3,009.60
|
| Rate for Payer: GEHA Medicare |
$759.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Humana ChoiceCare |
$835.48
|
| Rate for Payer: Humana Medicare Advantage |
$759.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,276.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$920.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$759.53
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,291.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,063.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$920.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$759.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,519.06
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$744.34
|
| Rate for Payer: United Healthcare Commercial |
$3,197.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$920.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$759.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$759.53
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
| Rate for Payer: Zelis Medicare |
$645.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$911.44
|
| Rate for Payer: Zelis Worker's Compensation |
$606.95
|
|
|
TBO- FILGRASTIM 300 MCG/1 ML SDV INJ
|
Facility
|
IP
|
$515.40
|
|
|
Service Code
|
CPT J1447
|
| Hospital Charge Code |
3303164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$489.63 |
| Rate for Payer: Cash Price |
$309.24
|
| Rate for Payer: Cigna Commercial |
$438.09
|
| Rate for Payer: First Health Commercial |
$463.86
|
| Rate for Payer: First Health Workers Compensation |
$199.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.86
|
| Rate for Payer: GEHA Commercial |
$360.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.86
|
| Rate for Payer: Multiplan All |
$469.01
|
| Rate for Payer: OMNI Networks Commercial |
$360.78
|
| Rate for Payer: One Health Plan PPO/POS |
$463.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.63
|
| Rate for Payer: Three Rivers Provider Network All |
$386.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$479.32
|
| Rate for Payer: Zelis Auto |
$206.16
|
| Rate for Payer: Zelis Worker's Compensation |
$140.70
|
|
|
TBO- FILGRASTIM 300 MCG/1 ML SDV INJ
|
Facility
|
OP
|
$515.40
|
|
|
Service Code
|
CPT J1447
|
| Hospital Charge Code |
3303164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$489.63 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$0.28
|
| Rate for Payer: Cash Price |
$309.24
|
| Rate for Payer: Cash Price |
$309.24
|
| Rate for Payer: Cigna Commercial |
$438.09
|
| Rate for Payer: First Health Commercial |
$463.86
|
| Rate for Payer: First Health Workers Compensation |
$199.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.86
|
| Rate for Payer: GEHA Commercial |
$0.31
|
| Rate for Payer: GEHA Medicare |
$0.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.86
|
| Rate for Payer: Humana ChoiceCare |
$0.31
|
| Rate for Payer: Humana Medicare Advantage |
$0.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$0.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$0.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$0.28
|
| Rate for Payer: Multiplan All |
$469.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.48
|
| Rate for Payer: OMNI Networks Commercial |
$360.78
|
| Rate for Payer: One Health Plan PPO/POS |
$463.86
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$0.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$0.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$0.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.63
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$0.56
|
| Rate for Payer: Three Rivers Provider Network All |
$386.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$479.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$0.28
|
| Rate for Payer: Zelis Auto |
$206.16
|
| Rate for Payer: Zelis Medicare |
$0.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.34
|
| Rate for Payer: Zelis Worker's Compensation |
$140.70
|
|
|
TB SKIN TEST INTRADERMAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
21600328
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TB SKIN TEST INTRADERMAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
21600328
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TB SKIN TEST INTRADERMAL
|
Facility
|
IP
|
$24.49
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
7286580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cigna Commercial |
$20.82
|
| Rate for Payer: First Health Commercial |
$22.04
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.04
|
| Rate for Payer: GEHA Commercial |
$17.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.04
|
| Rate for Payer: Multiplan All |
$22.29
|
| Rate for Payer: OMNI Networks Commercial |
$17.14
|
| Rate for Payer: One Health Plan PPO/POS |
$22.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.27
|
| Rate for Payer: Three Rivers Provider Network All |
$18.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.78
|
| Rate for Payer: Zelis Auto |
$9.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TB SKIN TEST INTRADERMAL
|
Facility
|
OP
|
$24.49
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
7286580
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cigna Commercial |
$20.82
|
| Rate for Payer: First Health Commercial |
$22.04
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.04
|
| Rate for Payer: GEHA Commercial |
$19.59
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.04
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$22.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$17.14
|
| Rate for Payer: One Health Plan PPO/POS |
$22.04
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$18.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$20.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$9.80
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TB SKIN TEST INTRADERMAL
|
Facility
|
OP
|
$24.49
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
8586580
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cigna Commercial |
$20.82
|
| Rate for Payer: First Health Commercial |
$22.04
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.04
|
| Rate for Payer: GEHA Commercial |
$19.59
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.04
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$22.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$17.14
|
| Rate for Payer: One Health Plan PPO/POS |
$22.04
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$18.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$9.80
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TB SKIN TEST INTRADERMAL
|
Facility
|
IP
|
$24.49
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
8586580
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cigna Commercial |
$20.82
|
| Rate for Payer: First Health Commercial |
$22.04
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.04
|
| Rate for Payer: GEHA Commercial |
$17.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.04
|
| Rate for Payer: Multiplan All |
$22.29
|
| Rate for Payer: OMNI Networks Commercial |
$17.14
|
| Rate for Payer: One Health Plan PPO/POS |
$22.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.27
|
| Rate for Payer: Three Rivers Provider Network All |
$18.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.78
|
| Rate for Payer: Zelis Auto |
$9.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TECHNETIUM TC-99M PYROPHOS 10 ML INJ
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
3303086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.02 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$351.90
|
| Rate for Payer: First Health Commercial |
$372.60
|
| Rate for Payer: First Health Workers Compensation |
$159.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$372.60
|
| Rate for Payer: GEHA Commercial |
$289.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$372.60
|
| Rate for Payer: Multiplan All |
$376.74
|
| Rate for Payer: OMNI Networks Commercial |
$289.80
|
| Rate for Payer: One Health Plan PPO/POS |
$372.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$393.30
|
| Rate for Payer: Three Rivers Provider Network All |
$310.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.02
|
| Rate for Payer: Zelis Auto |
$165.60
|
| Rate for Payer: Zelis Worker's Compensation |
$113.02
|
|
|
TECHNETIUM TC-99M PYROPHOS 10 ML INJ
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
3303086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$351.90
|
| Rate for Payer: First Health Commercial |
$372.60
|
| Rate for Payer: First Health Workers Compensation |
$159.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$372.60
|
| Rate for Payer: GEHA Commercial |
$331.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$372.60
|
| Rate for Payer: Humana ChoiceCare |
$107.64
|
| Rate for Payer: Multiplan All |
$376.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$248.40
|
| Rate for Payer: OMNI Networks Commercial |
$289.80
|
| Rate for Payer: One Health Plan PPO/POS |
$372.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$393.30
|
| Rate for Payer: Three Rivers Provider Network All |
$310.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$364.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.02
|
| Rate for Payer: Zelis Auto |
$165.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.00
|
| Rate for Payer: Zelis Worker's Compensation |
$113.02
|
|
|
TELEHEALTH CONSULT, ED/IP, 30 MINS
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT G0425
|
| Hospital Charge Code |
8400425
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Cash Price |
$181.20
|
| Rate for Payer: Cigna Commercial |
$256.70
|
| Rate for Payer: First Health Commercial |
$271.80
|
| Rate for Payer: First Health Workers Compensation |
$116.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$271.80
|
| Rate for Payer: GEHA Commercial |
$211.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$271.80
|
| Rate for Payer: Multiplan All |
$274.82
|
| Rate for Payer: OMNI Networks Commercial |
$211.40
|
| Rate for Payer: One Health Plan PPO/POS |
$271.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$286.90
|
| Rate for Payer: Three Rivers Provider Network All |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$280.86
|
| Rate for Payer: Zelis Auto |
$120.80
|
| Rate for Payer: Zelis Worker's Compensation |
$82.45
|
|
|
TELEHEALTH CONSULT, ED/IP, 30 MINS
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT G0425
|
| Hospital Charge Code |
8400425
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$75.50 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$181.20
|
| Rate for Payer: Cash Price |
$181.20
|
| Rate for Payer: Cigna Commercial |
$256.70
|
| Rate for Payer: First Health Commercial |
$271.80
|
| Rate for Payer: First Health Workers Compensation |
$116.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$271.80
|
| Rate for Payer: GEHA Commercial |
$241.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$271.80
|
| Rate for Payer: Humana ChoiceCare |
$78.52
|
| Rate for Payer: Multiplan All |
$274.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$181.20
|
| Rate for Payer: OMNI Networks Commercial |
$211.40
|
| Rate for Payer: One Health Plan PPO/POS |
$271.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$286.90
|
| Rate for Payer: Three Rivers Provider Network All |
$226.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$265.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$280.86
|
| Rate for Payer: Zelis Auto |
$120.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$151.00
|
| Rate for Payer: Zelis Worker's Compensation |
$82.45
|
|
|
TELEHEALTH CONSULT, ED/IP, 50 MINS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT G0426
|
| Hospital Charge Code |
8400426
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$105.04
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$242.40
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$355.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
TELEHEALTH CONSULT, ED/IP, 50 MINS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT G0426
|
| Hospital Charge Code |
8400426
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
TELEHEALTH ORIGINATING SITE FACILITY FEE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
8403014
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.16
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$101.15
|
| Rate for Payer: First Health Commercial |
$107.10
|
| Rate for Payer: First Health Workers Compensation |
$45.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$107.10
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$107.10
|
| Rate for Payer: Humana ChoiceCare |
$30.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.90
|
| Rate for Payer: Multiplan All |
$108.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$71.40
|
| Rate for Payer: OMNI Networks Commercial |
$83.30
|
| Rate for Payer: One Health Plan PPO/POS |
$107.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$113.05
|
| Rate for Payer: Three Rivers Provider Network All |
$89.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$104.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$110.67
|
| Rate for Payer: Zelis Auto |
$47.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$59.50
|
| Rate for Payer: Zelis Worker's Compensation |
$32.49
|
|
|
TELEHEALTH ORIGINATING SITE FACILITY FEE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
8403014
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$101.15
|
| Rate for Payer: First Health Commercial |
$107.10
|
| Rate for Payer: First Health Workers Compensation |
$45.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$107.10
|
| Rate for Payer: GEHA Commercial |
$83.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$107.10
|
| Rate for Payer: Multiplan All |
$108.29
|
| Rate for Payer: OMNI Networks Commercial |
$83.30
|
| Rate for Payer: One Health Plan PPO/POS |
$107.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$113.05
|
| Rate for Payer: Three Rivers Provider Network All |
$89.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$110.67
|
| Rate for Payer: Zelis Auto |
$47.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.49
|
|
|
TELEMED CITY OF ARTESIA OFFICE VISIT
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8599503
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
TELEMED CITY OF ARTESIA OFFICE VISIT
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8599503
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
TELEMED CURRENTLY PUMPING TRAINING
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
20500103
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
TELEMED CURRENTLY PUMPING TRAINING
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
20500103
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
