|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 23660
|
| Hospital Charge Code |
6123660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$323.78 |
| Max. Negotiated Rate |
$1,126.70 |
| Rate for Payer: Cash Price |
$711.60
|
| Rate for Payer: Cigna Commercial |
$1,008.10
|
| Rate for Payer: First Health Commercial |
$1,067.40
|
| Rate for Payer: First Health Workers Compensation |
$457.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,067.40
|
| Rate for Payer: GEHA Commercial |
$830.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,067.40
|
| Rate for Payer: Multiplan All |
$1,079.26
|
| Rate for Payer: OMNI Networks Commercial |
$830.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,067.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,126.70
|
| Rate for Payer: Three Rivers Provider Network All |
$889.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,102.98
|
| Rate for Payer: Zelis Auto |
$474.40
|
| Rate for Payer: Zelis Worker's Compensation |
$323.78
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$1,237.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
6123655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.70 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$742.20
|
| Rate for Payer: Cash Price |
$742.20
|
| Rate for Payer: Cigna Commercial |
$1,051.45
|
| Rate for Payer: First Health Commercial |
$1,113.30
|
| Rate for Payer: First Health Workers Compensation |
$477.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,113.30
|
| Rate for Payer: GEHA Commercial |
$989.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,113.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,125.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$865.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,113.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,175.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$927.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,150.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$494.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$337.70
|
|
|
TREAT SKULL FRACTURE
|
Facility
|
IP
|
$2,659.00
|
|
|
Service Code
|
CPT 62005
|
| Hospital Charge Code |
6162005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$725.91 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cigna Commercial |
$2,260.15
|
| Rate for Payer: First Health Commercial |
$2,393.10
|
| Rate for Payer: First Health Workers Compensation |
$1,026.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,393.10
|
| Rate for Payer: GEHA Commercial |
$1,861.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,393.10
|
| Rate for Payer: Multiplan All |
$2,419.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,861.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,393.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,526.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,994.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,472.87
|
| Rate for Payer: Zelis Auto |
$1,063.60
|
| Rate for Payer: Zelis Worker's Compensation |
$725.91
|
|
|
TREAT SKULL FRACTURE
|
Facility
|
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
6162000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.42 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,328.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$1,328.40
|
| Rate for Payer: Cash Price |
$1,328.40
|
| Rate for Payer: Cigna Commercial |
$1,881.90
|
| Rate for Payer: First Health Commercial |
$1,992.60
|
| Rate for Payer: First Health Workers Compensation |
$854.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,992.60
|
| Rate for Payer: GEHA Commercial |
$1,771.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,992.60
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$2,014.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,992.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,103.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,660.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,059.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$885.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$604.42
|
|
|
TREAT SKULL FRACTURE
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
6162000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.42 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Cash Price |
$1,328.40
|
| Rate for Payer: Cigna Commercial |
$1,881.90
|
| Rate for Payer: First Health Commercial |
$1,992.60
|
| Rate for Payer: First Health Workers Compensation |
$854.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,992.60
|
| Rate for Payer: GEHA Commercial |
$1,549.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,992.60
|
| Rate for Payer: Multiplan All |
$2,014.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,549.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,992.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,103.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,660.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,059.02
|
| Rate for Payer: Zelis Auto |
$885.60
|
| Rate for Payer: Zelis Worker's Compensation |
$604.42
|
|
|
TREAT SKULL FRACTURE
|
Facility
|
OP
|
$2,659.00
|
|
|
Service Code
|
CPT 62005
|
| Hospital Charge Code |
6162005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$664.75 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,595.40
|
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cigna Commercial |
$2,260.15
|
| Rate for Payer: First Health Commercial |
$2,393.10
|
| Rate for Payer: First Health Workers Compensation |
$1,026.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,393.10
|
| Rate for Payer: GEHA Commercial |
$2,127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,393.10
|
| Rate for Payer: Humana ChoiceCare |
$691.34
|
| Rate for Payer: Multiplan All |
$2,419.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,595.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,861.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,393.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,526.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,994.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,339.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$664.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,472.87
|
| Rate for Payer: Zelis Auto |
$1,063.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,329.50
|
| Rate for Payer: Zelis Worker's Compensation |
$725.91
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 27175
|
| Hospital Charge Code |
6127175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$960.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 27176
|
| Hospital Charge Code |
6127176
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$505.05 |
| Max. Negotiated Rate |
$1,757.50 |
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,572.50
|
| Rate for Payer: First Health Commercial |
$1,665.00
|
| Rate for Payer: First Health Workers Compensation |
$714.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,665.00
|
| Rate for Payer: GEHA Commercial |
$1,295.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,665.00
|
| Rate for Payer: Multiplan All |
$1,683.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,295.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,665.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,757.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,387.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,720.50
|
| Rate for Payer: Zelis Auto |
$740.00
|
| Rate for Payer: Zelis Worker's Compensation |
$505.05
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
CPT 27181
|
| Hospital Charge Code |
6127181
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.45 |
| Max. Negotiated Rate |
$1,887.65 |
| Rate for Payer: Cash Price |
$1,192.20
|
| Rate for Payer: Cigna Commercial |
$1,688.95
|
| Rate for Payer: First Health Commercial |
$1,788.30
|
| Rate for Payer: First Health Workers Compensation |
$767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,788.30
|
| Rate for Payer: GEHA Commercial |
$1,390.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,788.30
|
| Rate for Payer: Multiplan All |
$1,808.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,390.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,788.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,887.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,490.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,847.91
|
| Rate for Payer: Zelis Auto |
$794.80
|
| Rate for Payer: Zelis Worker's Compensation |
$542.45
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
CPT 27181
|
| Hospital Charge Code |
6127181
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$496.75 |
| Max. Negotiated Rate |
$1,887.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,192.20
|
| Rate for Payer: Cash Price |
$1,192.20
|
| Rate for Payer: Cigna Commercial |
$1,688.95
|
| Rate for Payer: First Health Commercial |
$1,788.30
|
| Rate for Payer: First Health Workers Compensation |
$767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,788.30
|
| Rate for Payer: GEHA Commercial |
$1,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,788.30
|
| Rate for Payer: Humana ChoiceCare |
$516.62
|
| Rate for Payer: Multiplan All |
$1,808.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,192.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,390.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,788.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,887.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,490.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,748.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$496.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,847.91
|
| Rate for Payer: Zelis Auto |
$794.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$993.50
|
| Rate for Payer: Zelis Worker's Compensation |
$542.45
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
CPT 27178
|
| Hospital Charge Code |
6127178
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$515.70 |
| Max. Negotiated Rate |
$1,794.55 |
| Rate for Payer: Cash Price |
$1,133.40
|
| Rate for Payer: Cigna Commercial |
$1,605.65
|
| Rate for Payer: First Health Commercial |
$1,700.10
|
| Rate for Payer: First Health Workers Compensation |
$729.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,700.10
|
| Rate for Payer: GEHA Commercial |
$1,322.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,700.10
|
| Rate for Payer: Multiplan All |
$1,718.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,322.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,700.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,794.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,756.77
|
| Rate for Payer: Zelis Auto |
$755.60
|
| Rate for Payer: Zelis Worker's Compensation |
$515.70
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 27175
|
| Hospital Charge Code |
6127175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$1,097.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Humana ChoiceCare |
$356.72
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$823.20
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,207.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$343.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$686.00
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
IP
|
$2,298.00
|
|
|
Service Code
|
CPT 27177
|
| Hospital Charge Code |
6127177
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.35 |
| Max. Negotiated Rate |
$2,183.10 |
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$1,953.30
|
| Rate for Payer: First Health Commercial |
$2,068.20
|
| Rate for Payer: First Health Workers Compensation |
$887.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,068.20
|
| Rate for Payer: GEHA Commercial |
$1,608.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,068.20
|
| Rate for Payer: Multiplan All |
$2,091.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,608.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,068.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,183.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,723.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,137.14
|
| Rate for Payer: Zelis Auto |
$919.20
|
| Rate for Payer: Zelis Worker's Compensation |
$627.35
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 27176
|
| Hospital Charge Code |
6127176
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.50 |
| Max. Negotiated Rate |
$1,757.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,572.50
|
| Rate for Payer: First Health Commercial |
$1,665.00
|
| Rate for Payer: First Health Workers Compensation |
$714.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,665.00
|
| Rate for Payer: GEHA Commercial |
$1,480.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,665.00
|
| Rate for Payer: Humana ChoiceCare |
$481.00
|
| Rate for Payer: Multiplan All |
$1,683.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,110.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,295.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,665.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,757.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,387.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,628.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$462.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,720.50
|
| Rate for Payer: Zelis Auto |
$740.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$925.00
|
| Rate for Payer: Zelis Worker's Compensation |
$505.05
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
CPT 27178
|
| Hospital Charge Code |
6127178
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$472.25 |
| Max. Negotiated Rate |
$1,794.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,133.40
|
| Rate for Payer: Cash Price |
$1,133.40
|
| Rate for Payer: Cigna Commercial |
$1,605.65
|
| Rate for Payer: First Health Commercial |
$1,700.10
|
| Rate for Payer: First Health Workers Compensation |
$729.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,700.10
|
| Rate for Payer: GEHA Commercial |
$1,511.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,700.10
|
| Rate for Payer: Humana ChoiceCare |
$491.14
|
| Rate for Payer: Multiplan All |
$1,718.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,133.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,322.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,700.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,794.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,662.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,756.77
|
| Rate for Payer: Zelis Auto |
$755.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$944.50
|
| Rate for Payer: Zelis Worker's Compensation |
$515.70
|
|
|
TREAT SLIPPED EPIPHYSIS
|
Facility
|
OP
|
$2,298.00
|
|
|
Service Code
|
CPT 27177
|
| Hospital Charge Code |
6127177
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.50 |
| Max. Negotiated Rate |
$2,183.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,378.80
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$1,953.30
|
| Rate for Payer: First Health Commercial |
$2,068.20
|
| Rate for Payer: First Health Workers Compensation |
$887.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,068.20
|
| Rate for Payer: GEHA Commercial |
$1,838.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,068.20
|
| Rate for Payer: Humana ChoiceCare |
$597.48
|
| Rate for Payer: Multiplan All |
$2,091.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,378.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,608.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,068.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,183.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,723.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,022.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,137.14
|
| Rate for Payer: Zelis Auto |
$919.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,149.00
|
| Rate for Payer: Zelis Worker's Compensation |
$627.35
|
|
|
TREAT SPINE FRACTURE
|
Facility
|
OP
|
$3,014.00
|
|
|
Service Code
|
CPT 22325
|
| Hospital Charge Code |
6122325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$753.50 |
| Max. Negotiated Rate |
$2,863.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna Commercial |
$2,561.90
|
| Rate for Payer: First Health Commercial |
$2,712.60
|
| Rate for Payer: First Health Workers Compensation |
$1,163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,712.60
|
| Rate for Payer: GEHA Commercial |
$2,411.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,712.60
|
| Rate for Payer: Humana ChoiceCare |
$783.64
|
| Rate for Payer: Multiplan All |
$2,742.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,808.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,109.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,712.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,863.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,260.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,652.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$753.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,803.02
|
| Rate for Payer: Zelis Auto |
$1,205.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,507.00
|
| Rate for Payer: Zelis Worker's Compensation |
$822.82
|
|
|
TREAT SPINE FRACTURE
|
Facility
|
IP
|
$3,014.00
|
|
|
Service Code
|
CPT 22325
|
| Hospital Charge Code |
6122325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.82 |
| Max. Negotiated Rate |
$2,863.30 |
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna Commercial |
$2,561.90
|
| Rate for Payer: First Health Commercial |
$2,712.60
|
| Rate for Payer: First Health Workers Compensation |
$1,163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,712.60
|
| Rate for Payer: GEHA Commercial |
$2,109.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,712.60
|
| Rate for Payer: Multiplan All |
$2,742.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,109.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,712.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,863.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,260.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,803.02
|
| Rate for Payer: Zelis Auto |
$1,205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$822.82
|
|
|
TREAT STERNUM FRACTURE
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 21820
|
| Hospital Charge Code |
6121820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
TREAT STERNUM FRACTURE
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 21825
|
| Hospital Charge Code |
6121825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$897.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Humana ChoiceCare |
$291.72
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$673.20
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$987.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$561.00
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
TREAT STERNUM FRACTURE
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 21820
|
| Hospital Charge Code |
6121820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
TREAT STERNUM FRACTURE
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 21825
|
| Hospital Charge Code |
6121825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$785.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
TREAT TAIL BONE FRACTURE
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 27202
|
| Hospital Charge Code |
6127202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$296.20 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna Commercial |
$922.25
|
| Rate for Payer: First Health Commercial |
$976.50
|
| Rate for Payer: First Health Workers Compensation |
$418.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$976.50
|
| Rate for Payer: GEHA Commercial |
$868.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$976.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$987.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$759.50
|
| Rate for Payer: One Health Plan PPO/POS |
$976.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,030.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$813.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$434.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$296.20
|
|
|
TREAT TAIL BONE FRACTURE
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
6127200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$217.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$451.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$153.97
|
|
|
TREAT TAIL BONE FRACTURE
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
6127200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.97 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$217.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$394.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Worker's Compensation |
$153.97
|
|
