|
CHROMOSOME ANALYSIS 20-25
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2200769
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$577.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$144.61
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$189.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$770.40
|
| Rate for Payer: GEHA Medicare |
$144.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| Rate for Payer: Humana ChoiceCare |
$159.07
|
| Rate for Payer: Humana Medicare Advantage |
$144.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$242.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$144.61
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$245.84
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$144.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$289.22
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$141.72
|
| Rate for Payer: United Healthcare Commercial |
$818.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$240.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$144.61
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Medicare |
$122.92
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$173.53
|
| Rate for Payer: Zelis Worker's Compensation |
$134.34
|
|
|
CHRON CARE MANAGEMENT SRVC 20 MIN BEHAV
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT G0512
|
| Hospital Charge Code |
9199512
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CHRON CARE MANAGEMENT SRVC 20 MIN BEHAV
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT G0512
|
| Hospital Charge Code |
9199512
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CHRON CARE MANAGEMENT SRVC 20 MIN PER MO
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9199490
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CHRON CARE MANAGEMENT SRVC 20 MIN PER MO
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9199490
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CHRONIC CARE MGMT SERVICES EA ADD 20 MIN
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9199439
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$65.45
|
| Rate for Payer: First Health Commercial |
$69.30
|
| Rate for Payer: First Health Workers Compensation |
$29.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$69.30
|
| Rate for Payer: GEHA Commercial |
$61.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$69.30
|
| Rate for Payer: Humana ChoiceCare |
$20.02
|
| Rate for Payer: Multiplan All |
$70.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.20
|
| Rate for Payer: OMNI Networks Commercial |
$53.90
|
| Rate for Payer: One Health Plan PPO/POS |
$69.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$73.15
|
| Rate for Payer: Three Rivers Provider Network All |
$57.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$67.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$71.61
|
| Rate for Payer: Zelis Auto |
$30.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$38.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.02
|
|
|
CHRONIC CARE MGMT SERVICES EA ADD 20 MIN
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9199439
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$65.45
|
| Rate for Payer: First Health Commercial |
$69.30
|
| Rate for Payer: First Health Workers Compensation |
$29.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$69.30
|
| Rate for Payer: GEHA Commercial |
$53.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$69.30
|
| Rate for Payer: Multiplan All |
$70.07
|
| Rate for Payer: OMNI Networks Commercial |
$53.90
|
| Rate for Payer: One Health Plan PPO/POS |
$69.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$73.15
|
| Rate for Payer: Three Rivers Provider Network All |
$57.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$71.61
|
| Rate for Payer: Zelis Auto |
$30.80
|
| Rate for Payer: Zelis Worker's Compensation |
$21.02
|
|
|
CHRONIC CARE MGMT SVCS, EA ADD 20 MIN
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT G2058
|
| Hospital Charge Code |
9102058
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$72.25
|
| Rate for Payer: First Health Commercial |
$76.50
|
| Rate for Payer: First Health Workers Compensation |
$32.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$76.50
|
| Rate for Payer: GEHA Commercial |
$68.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$76.50
|
| Rate for Payer: Humana ChoiceCare |
$22.10
|
| Rate for Payer: Multiplan All |
$77.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$51.00
|
| Rate for Payer: OMNI Networks Commercial |
$59.50
|
| Rate for Payer: One Health Plan PPO/POS |
$76.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$80.75
|
| Rate for Payer: Three Rivers Provider Network All |
$63.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$74.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.05
|
| Rate for Payer: Zelis Auto |
$34.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.50
|
| Rate for Payer: Zelis Worker's Compensation |
$23.20
|
|
|
CHRONIC CARE MGMT SVCS, EA ADD 20 MIN
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT G2058
|
| Hospital Charge Code |
9102058
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$72.25
|
| Rate for Payer: First Health Commercial |
$76.50
|
| Rate for Payer: First Health Workers Compensation |
$32.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$76.50
|
| Rate for Payer: GEHA Commercial |
$59.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$76.50
|
| Rate for Payer: Multiplan All |
$77.35
|
| Rate for Payer: OMNI Networks Commercial |
$59.50
|
| Rate for Payer: One Health Plan PPO/POS |
$76.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$80.75
|
| Rate for Payer: Three Rivers Provider Network All |
$63.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.05
|
| Rate for Payer: Zelis Auto |
$34.00
|
| Rate for Payer: Zelis Worker's Compensation |
$23.20
|
|
|
CILOSTAZOL 100MG TAB
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 00093206406
|
| Hospital Charge Code |
3300179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CILOSTAZOL 100MG TAB
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 00093206406
|
| Hospital Charge Code |
3300179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
cinnamon, IgE REF602781
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200445
|
|
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
|
|
|
cinnamon, IgE REF602781
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200445
|
|
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
|
|
|
CIPROFLOXACIN 400MG/200ML IN D5W
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT J0706
|
| Hospital Charge Code |
3300180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$4.68
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.80
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
CIPROFLOXACIN 400MG/200ML IN D5W
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT J0706
|
| Hospital Charge Code |
3300180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
CIPROFLOXACIN 500MG TAB
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300182
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Humana ChoiceCare |
$9.62
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.20
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
CIPROFLOXACIN 500MG TAB
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300182
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$25.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
CIPROFLOXACIN HCL 0.3% EYE DROPS
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
3300181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$36.40
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$123.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
CIPROFLOXACIN HCL 0.3% EYE DROPS
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 61314065625
|
| Hospital Charge Code |
3300181
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
6154161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$494.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
9200012
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$494.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
6154161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$587.10 |
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$432.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
9200012
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$587.10 |
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$432.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
CIRCUMCISION NEONATE
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 54160
|
| Hospital Charge Code |
6154160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.12 |
| Max. Negotiated Rate |
$2,354.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$270.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$383.35
|
| Rate for Payer: First Health Commercial |
$405.90
|
| Rate for Payer: First Health Workers Compensation |
$174.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.90
|
| Rate for Payer: GEHA Commercial |
$360.80
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.90
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$410.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$315.70
|
| Rate for Payer: One Health Plan PPO/POS |
$405.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$428.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$338.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$419.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$180.40
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$123.12
|
|
|
CIRCUMCISION NEONATE
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 54160
|
| Hospital Charge Code |
6154160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.12 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$383.35
|
| Rate for Payer: First Health Commercial |
$405.90
|
| Rate for Payer: First Health Workers Compensation |
$174.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.90
|
| Rate for Payer: GEHA Commercial |
$315.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.90
|
| Rate for Payer: Multiplan All |
$410.41
|
| Rate for Payer: OMNI Networks Commercial |
$315.70
|
| Rate for Payer: One Health Plan PPO/POS |
$405.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$428.45
|
| Rate for Payer: Three Rivers Provider Network All |
$338.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$419.43
|
| Rate for Payer: Zelis Auto |
$180.40
|
| Rate for Payer: Zelis Worker's Compensation |
$123.12
|
|
