|
CKMB (Vitros)
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
2232189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$17.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$11.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$12.71
|
| Rate for Payer: Humana Medicare Advantage |
$11.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.55
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.64
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.10
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.32
|
| Rate for Payer: United Healthcare Commercial |
$141.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.55
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$9.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.86
|
| Rate for Payer: Zelis Worker's Compensation |
$12.43
|
|
|
CKMB (Vitros)
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
2232189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$17.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.43
|
|
|
CK TOTAL (Vitros)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
2232190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$11.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.24
|
|
|
CK TOTAL (Vitros)
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
2232190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$11.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$6.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$7.16
|
| Rate for Payer: Humana Medicare Advantage |
$6.51
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.51
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.07
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.02
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.38
|
| Rate for Payer: United Healthcare Commercial |
$127.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.51
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$5.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.81
|
| Rate for Payer: Zelis Worker's Compensation |
$8.24
|
|
|
CL- ABRAXANE 1 MG
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT J9264
|
| Hospital Charge Code |
3350273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$11.59
|
| Rate for Payer: GEHA Medicare |
$10.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$11.59
|
| Rate for Payer: Humana Medicare Advantage |
$10.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.54
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.92
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.08
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.54
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$8.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.65
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
CL- ABRAXANE 1 MG
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT J9264
|
| Hospital Charge Code |
3350273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
CL- ACETAMINOPHEN 160MG/5ML U.D. SOLN
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
CL- ACETAMINOPHEN 160MG/5ML U.D. SOLN
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
CL- ACETAMINOPHEN TAB 325MG
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CL- ACETAMINOPHEN TAB 325MG
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CL- ACETAMINOPHEN TAB 500 MG
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CL- ACETAMINOPHEN TAB 500 MG
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
cladosporium herbarum REF602462
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299144
|
|
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
|
|
|
cladosporium herbarum REF602462
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299144
|
|
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
|
|
|
CL- ADO-TRASTUZUMAB EMTANSINE 1 MG
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
3350320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$66.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
CL- ADO-TRASTUZUMAB EMTANSINE 1 MG
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT J9354
|
| Hospital Charge Code |
3350320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$42.16
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$46.38
|
| Rate for Payer: GEHA Medicare |
$42.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$46.38
|
| Rate for Payer: Humana Medicare Advantage |
$42.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$70.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$42.16
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$71.67
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$42.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$84.32
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$42.16
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Medicare |
$35.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.59
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
CL- ALBUTEROL 0.042% IN 3 mL U.D.
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
3350408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CL- ALBUTEROL 0.042% IN 3 mL U.D.
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
3350408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$0.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CL- ALBUTEROL 0.083% U.D.
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
3350004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CL- ALBUTEROL 0.083% U.D.
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
3350004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$0.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CL- ALBUTEROL 90 MCG/ PUFF - PER PUFF
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
3350438
|
|
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
|
|
|
CL- ALBUTEROL 90 MCG/ PUFF - PER PUFF
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
3350438
|
|
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
|
|
|
CL- ALIMTA 10 MG
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT J9305
|
| Hospital Charge Code |
3350276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.36
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$80.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: GEHA Medicare |
$4.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Humana ChoiceCare |
$4.80
|
| Rate for Payer: Humana Medicare Advantage |
$4.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.36
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.41
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.72
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.36
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Medicare |
$3.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.23
|
| Rate for Payer: Zelis Worker's Compensation |
$56.78
|
|
|
CL- ALIMTA 10 MG
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT J9305
|
| Hospital Charge Code |
3350276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$80.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Worker's Compensation |
$56.78
|
|
|
CL- ALUM MAG HYD SIMETH U.D.
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 00121176130
|
| Hospital Charge Code |
3350005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
