|
CL- EPINEPHRINE SQ/IM INJ - 1MG/ML
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
3350033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
CL- EPOETIN ALFA-EPBX 10000 UN/ML
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3350441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$8.63
|
| Rate for Payer: GEHA Medicare |
$7.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$8.63
|
| Rate for Payer: Humana Medicare Advantage |
$7.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.85
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.35
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.70
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.85
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Medicare |
$6.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.42
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
CL- EPOETIN ALFA-EPBX 10000 UN/ML
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3350441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
CL- EPOETIN ALFA-EPBX 10000 UN/ML PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3350499
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$8.63
|
| Rate for Payer: GEHA Medicare |
$7.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$8.63
|
| Rate for Payer: Humana Medicare Advantage |
$7.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.85
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.35
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.70
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.85
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$6.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.42
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- EPOETIN ALFA-EPBX 10000 UN/ML PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3350499
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- EPOETIN ALFA INJ 1000 UNITS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3350349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| 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 |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| 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 |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| 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 |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
CL- EPOETIN ALFA INJ 1000 UNITS
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3350349
|
|
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- ERIBULIN MESYLATE 0.1 MG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
3350311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
|
CL- ERIBULIN MESYLATE 0.1 MG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
3350311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.94 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$150.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$150.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$89.34
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$98.27
|
| Rate for Payer: GEHA Medicare |
$89.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Humana ChoiceCare |
$98.27
|
| Rate for Payer: Humana Medicare Advantage |
$89.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$150.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$121.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$89.34
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.88
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$121.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$89.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$178.68
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$89.34
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Medicare |
$75.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.21
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
|
CL- ESTRADIOL CYPIONATE IM 5MG/ML
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
3350035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$1,024.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: First Health Workers Compensation |
$416.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$54.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Humana ChoiceCare |
$280.28
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$646.80
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$948.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$269.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$539.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.29
|
|
|
CL- ESTRADIOL CYPIONATE IM 5MG/ML
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
3350035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.29 |
| Max. Negotiated Rate |
$1,024.10 |
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: First Health Workers Compensation |
$416.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$754.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Worker's Compensation |
$294.29
|
|
|
CL- ESTRADIOL VALERATE IM 40MG/ML
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT J1380
|
| Hospital Charge Code |
3350036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
CL- ESTRADIOL VALERATE IM 40MG/ML
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT J1380
|
| Hospital Charge Code |
3350036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$7.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
CL- ETHYL CHLORIDE SPRAY
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 00386000103
|
| Hospital Charge Code |
3350121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
CL- ETHYL CHLORIDE SPRAY
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 00386000103
|
| Hospital Charge Code |
3350121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
CL- ETOPOSIDE 10 MG
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
CPT J9181
|
| Hospital Charge Code |
3350299
|
|
Hospital Revenue Code
|
636
|
| 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: 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 |
$1.03
|
| 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- ETOPOSIDE 10 MG
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
CPT J9181
|
| Hospital Charge Code |
3350299
|
|
Hospital Revenue Code
|
636
|
| 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- EUFLEXXA 20 MG/2 ML INJ
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT J7323
|
| Hospital Charge Code |
3350086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
CL- EUFLEXXA 20 MG/2 ML INJ
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT J7323
|
| Hospital Charge Code |
3350086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.58 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$222.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$222.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$176.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$112.45
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$123.69
|
| Rate for Payer: GEHA Medicare |
$112.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$123.69
|
| Rate for Payer: Humana Medicare Advantage |
$112.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$188.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$180.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$112.45
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$191.16
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$207.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$180.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$112.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$224.90
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$110.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$180.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$112.45
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Medicare |
$95.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.94
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
CL- EUFLEXXA INJ 20MG/2ML -PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J7323
|
| Hospital Charge Code |
3350233
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$224.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$222.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$222.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$176.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$112.45
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$123.69
|
| Rate for Payer: GEHA Medicare |
$112.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$123.69
|
| Rate for Payer: Humana Medicare Advantage |
$112.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$188.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$180.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$112.45
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$191.16
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$207.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$180.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$112.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$224.90
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$110.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$180.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$112.45
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$95.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.94
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- EUFLEXXA INJ 20MG/2ML -PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J7323
|
| Hospital Charge Code |
3350233
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- EYE STREAM
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
CL- EYE STREAM
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
CL- FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350437
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CL- FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350437
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
