|
vitamin E tocopherol REF070140
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
2247298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$24.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$140.00
|
| Rate for Payer: GEHA Medicare |
$14.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Humana ChoiceCare |
$15.60
|
| Rate for Payer: Humana Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.18
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.11
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.36
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.90
|
| Rate for Payer: United Healthcare Commercial |
$148.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.18
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Medicare |
$12.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.02
|
| Rate for Payer: Zelis Worker's Compensation |
$17.55
|
|
|
vitamin E tocopherol REF070140
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
2247298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: First Health Workers Compensation |
$24.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$122.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.55
|
|
|
VITAMIN K 1MG/0.5ML - PEDI
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
3300720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$3.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
VITAMIN K 1MG/0.5ML - PEDI
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
3300720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
vitamin k1 REF121200
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
2247353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.72
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$25.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$13.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$15.09
|
| Rate for Payer: Humana Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.72
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.32
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.44
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.45
|
| Rate for Payer: United Healthcare Commercial |
$153.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.72
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$11.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.46
|
| Rate for Payer: Zelis Worker's Compensation |
$17.91
|
|
|
vitamin k1 REF121200
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
2247353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$25.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$17.91
|
|
|
VITAMINS A & D OINTMENT
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
NDC 00168003501
|
| Hospital Charge Code |
3300943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$45.90
|
| Rate for Payer: First Health Commercial |
$48.60
|
| Rate for Payer: First Health Workers Compensation |
$20.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$48.60
|
| Rate for Payer: GEHA Commercial |
$43.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$48.60
|
| Rate for Payer: Humana ChoiceCare |
$14.04
|
| Rate for Payer: Multiplan All |
$49.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.40
|
| Rate for Payer: OMNI Networks Commercial |
$37.80
|
| Rate for Payer: One Health Plan PPO/POS |
$48.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$51.30
|
| Rate for Payer: Three Rivers Provider Network All |
$40.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$47.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$50.22
|
| Rate for Payer: Zelis Auto |
$21.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.74
|
|
|
VITAMINS A & D OINTMENT
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
NDC 00168003501
|
| Hospital Charge Code |
3300943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$45.90
|
| Rate for Payer: First Health Commercial |
$48.60
|
| Rate for Payer: First Health Workers Compensation |
$20.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$48.60
|
| Rate for Payer: GEHA Commercial |
$37.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$48.60
|
| Rate for Payer: Multiplan All |
$49.14
|
| Rate for Payer: OMNI Networks Commercial |
$37.80
|
| Rate for Payer: One Health Plan PPO/POS |
$48.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$51.30
|
| Rate for Payer: Three Rivers Provider Network All |
$40.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$50.22
|
| Rate for Payer: Zelis Auto |
$21.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.74
|
|
|
vit d 1 25dihydroxy(calcitriol)REF081091
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
2246211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$38.50
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$67.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: GEHA Medicare |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$42.35
|
| Rate for Payer: Humana Medicare Advantage |
$38.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$64.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$56.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$38.50
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.45
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$64.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$56.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$38.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$77.00
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$248.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$38.50
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Medicare |
$32.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.80
|
|
|
vit d 1 25dihydroxy(calcitriol)REF081091
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
2246211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$67.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$47.80
|
|
|
vit d 25 hydroxy REF081950
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2246114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
vit d 25 hydroxy REF081950
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2246114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$42.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: GEHA Medicare |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Humana Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$43.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.60
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.32
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$43.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59.20
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.01
|
| Rate for Payer: United Healthcare Commercial |
$282.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.60
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Medicare |
$25.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.52
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
vit d (d2+d3 frac) lc/ms-ms REF504115
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2200143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
vit d (d2+d3 frac) lc/ms-ms REF504115
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
2200143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$42.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$55.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: GEHA Medicare |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Humana Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$43.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.60
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.32
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$43.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59.20
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.01
|
| Rate for Payer: United Healthcare Commercial |
$282.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.60
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Medicare |
$25.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.52
|
| Rate for Payer: Zelis Worker's Compensation |
$38.95
|
|
|
vma random urine REF123208
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
2200040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$27.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$119.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Worker's Compensation |
$19.15
|
|
|
vma random urine REF123208
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
2200040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$27.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$136.80
|
| Rate for Payer: GEHA Medicare |
$15.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Humana ChoiceCare |
$17.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.50
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.35
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$31.00
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.19
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.50
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Medicare |
$13.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.15
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
6131630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$20.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
1002011
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
6136410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$23.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.40
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
8136410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$230.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Humana ChoiceCare |
$74.88
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$172.80
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$253.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$144.00
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
6136410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$20.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
336410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
1000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
6131630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$23.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.40
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
8136410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
