|
WEIGHT,TRACTION,CAST IRON #2
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
90007177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
WELCOME TO MEDICARE PHYSICAL
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
8599398
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$426.70
|
| Rate for Payer: First Health Commercial |
$451.80
|
| Rate for Payer: First Health Workers Compensation |
$193.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$451.80
|
| Rate for Payer: GEHA Commercial |
$401.60
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$456.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$351.40
|
| Rate for Payer: One Health Plan PPO/POS |
$451.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$476.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$376.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$466.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$200.80
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$137.05
|
|
|
WELCOME TO MEDICARE PHYSICAL
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
8599398
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.05 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$426.70
|
| Rate for Payer: First Health Commercial |
$451.80
|
| Rate for Payer: First Health Workers Compensation |
$193.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$451.80
|
| Rate for Payer: GEHA Commercial |
$351.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$451.80
|
| Rate for Payer: Multiplan All |
$456.82
|
| Rate for Payer: OMNI Networks Commercial |
$351.40
|
| Rate for Payer: One Health Plan PPO/POS |
$451.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$476.90
|
| Rate for Payer: Three Rivers Provider Network All |
$376.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$466.86
|
| Rate for Payer: Zelis Auto |
$200.80
|
| Rate for Payer: Zelis Worker's Compensation |
$137.05
|
|
|
WEST NILE VIRUS IGG
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
2246708
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$89.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$119.20
|
| Rate for Payer: GEHA Medicare |
$14.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Humana ChoiceCare |
$15.83
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.39
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.46
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.78
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$126.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.39
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Medicare |
$12.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.27
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
WEST NILE VIRUS IGG
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
2246708
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$21.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$104.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.53
|
|
|
WEST NILE VIRUS IGM
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
2246707
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$161.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$25.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$215.20
|
| Rate for Payer: GEHA Medicare |
$16.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Humana ChoiceCare |
$18.54
|
| Rate for Payer: Humana Medicare Advantage |
$16.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.85
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.64
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.70
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.51
|
| Rate for Payer: United Healthcare Commercial |
$228.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.85
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Medicare |
$14.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.22
|
| Rate for Payer: Zelis Worker's Compensation |
$18.07
|
|
|
WEST NILE VIRUS IGM
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
2246707
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$25.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$188.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Worker's Compensation |
$18.07
|
|
|
WET PREP
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
2207210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$7.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$5.10
|
|
|
WET PREP
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
2207210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$7.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: GEHA Medicare |
$5.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$6.40
|
| Rate for Payer: Humana Medicare Advantage |
$5.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.82
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.89
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.64
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.70
|
| Rate for Payer: United Healthcare Commercial |
$32.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.82
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Medicare |
$4.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.98
|
| Rate for Payer: Zelis Worker's Compensation |
$5.10
|
|
|
wheat IgE REF602459
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
wheat IgE REF602459
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
WHITE PETROLATUM OINT 5GM
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 58980035050
|
| Hospital Charge Code |
3302948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$1.70
|
| Rate for Payer: First Health Commercial |
$1.80
|
| Rate for Payer: First Health Workers Compensation |
$0.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1.80
|
| Rate for Payer: GEHA Commercial |
$1.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1.80
|
| Rate for Payer: Humana ChoiceCare |
$0.52
|
| Rate for Payer: Multiplan All |
$1.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.20
|
| Rate for Payer: OMNI Networks Commercial |
$1.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1.86
|
| Rate for Payer: Zelis Auto |
$0.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.55
|
|
|
WHITE PETROLATUM OINT 5GM
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 58980035050
|
| Hospital Charge Code |
3302948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$1.70
|
| Rate for Payer: First Health Commercial |
$1.80
|
| Rate for Payer: First Health Workers Compensation |
$0.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1.80
|
| Rate for Payer: GEHA Commercial |
$1.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1.80
|
| Rate for Payer: Multiplan All |
$1.82
|
| Rate for Payer: OMNI Networks Commercial |
$1.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1.86
|
| Rate for Payer: Zelis Auto |
$0.80
|
| Rate for Payer: Zelis Worker's Compensation |
$0.55
|
|
|
WHO COCK-UP NONMOLDE PRE OTS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
21600133
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
WHO COCK-UP NONMOLDE PRE OTS
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
21600133
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
WINDOWING OF CAST
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
6129730
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
WINDOWING OF CAST
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
6129730
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
WIPES PEROXIDE DISINFECTING
|
Facility
|
OP
|
$4,263.00
|
|
| Hospital Charge Code |
90000236
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,065.75 |
| Max. Negotiated Rate |
$4,049.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,557.80
|
| Rate for Payer: Cigna Commercial |
$3,623.55
|
| Rate for Payer: First Health Commercial |
$3,836.70
|
| Rate for Payer: First Health Workers Compensation |
$1,645.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,836.70
|
| Rate for Payer: GEHA Commercial |
$3,410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,836.70
|
| Rate for Payer: Humana ChoiceCare |
$1,108.38
|
| Rate for Payer: Multiplan All |
$3,879.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,557.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,984.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,836.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,049.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,751.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,065.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,964.59
|
| Rate for Payer: Zelis Auto |
$1,705.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,131.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,163.80
|
|
|
WIPES PEROXIDE DISINFECTING
|
Facility
|
IP
|
$4,263.00
|
|
| Hospital Charge Code |
90000236
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,163.80 |
| Max. Negotiated Rate |
$4,049.85 |
| Rate for Payer: Cash Price |
$2,557.80
|
| Rate for Payer: Cigna Commercial |
$3,623.55
|
| Rate for Payer: First Health Commercial |
$3,836.70
|
| Rate for Payer: First Health Workers Compensation |
$1,645.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,836.70
|
| Rate for Payer: GEHA Commercial |
$2,984.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,836.70
|
| Rate for Payer: Multiplan All |
$3,879.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,984.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,836.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,049.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,964.59
|
| Rate for Payer: Zelis Auto |
$1,705.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,163.80
|
|
|
WIRE-K 1.4X150MM
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
7009032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: First Health Workers Compensation |
$173.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$314.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Worker's Compensation |
$122.58
|
|
|
WIRE-K 1.4X150MM
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
7009032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.25 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: First Health Workers Compensation |
$173.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$359.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Humana ChoiceCare |
$116.74
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$269.40
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$395.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$112.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$224.50
|
| Rate for Payer: Zelis Worker's Compensation |
$122.58
|
|
|
WIRE-K POINT TROCAR DOUBLE .062
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
WIRE-K POINT TROCAR DOUBLE .062
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
|
WIRE-K POINT TROCAR DOUBLE .062
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90062242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
WIRE-K POINT TROCAR DOUBLE .062
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90062242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
