|
CLSD TX FX ULNAR STYLOID
|
Facility
|
IP
|
$1,473.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
8125650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$1,399.35 |
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,031.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: Zelis Auto |
$589.20
|
| Rate for Payer: Zelis Worker's Compensation |
$402.13
|
|
|
CLSD TX FX ULNAR STYLOID
|
Facility
|
OP
|
$1,473.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
8125650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,399.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$883.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,178.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$589.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$402.13
|
|
|
CLSD TX PELVIC RING FX W MANIPULATION
|
Facility
|
IP
|
$946.00
|
|
|
Service Code
|
CPT 27198
|
| Hospital Charge Code |
6191093
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.26 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$804.10
|
| Rate for Payer: First Health Commercial |
$851.40
|
| Rate for Payer: First Health Workers Compensation |
$365.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$851.40
|
| Rate for Payer: GEHA Commercial |
$662.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$851.40
|
| Rate for Payer: Multiplan All |
$860.86
|
| Rate for Payer: OMNI Networks Commercial |
$662.20
|
| Rate for Payer: One Health Plan PPO/POS |
$851.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$898.70
|
| Rate for Payer: Three Rivers Provider Network All |
$709.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$879.78
|
| Rate for Payer: Zelis Auto |
$378.40
|
| Rate for Payer: Zelis Worker's Compensation |
$258.26
|
|
|
CLSD TX PELVIC RING FX W MANIPULATION
|
Facility
|
OP
|
$946.00
|
|
|
Service Code
|
CPT 27198
|
| Hospital Charge Code |
6191093
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$567.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$804.10
|
| Rate for Payer: First Health Commercial |
$851.40
|
| Rate for Payer: First Health Workers Compensation |
$365.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$851.40
|
| Rate for Payer: GEHA Commercial |
$756.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$851.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$242.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$860.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$662.20
|
| Rate for Payer: One Health Plan PPO/POS |
$851.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$279.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$242.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$898.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$709.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$879.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$378.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$258.26
|
|
|
CLSD TX PELVIC RING FX WO MANIPULATION
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
6191092
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: First Health Workers Compensation |
$117.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
| Rate for Payer: Zelis Worker's Compensation |
$82.99
|
|
|
CLSD TX PELVIC RING FX WO MANIPULATION
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
6191092
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$182.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: First Health Workers Compensation |
$117.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$243.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$242.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$279.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$242.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$121.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$82.99
|
|
|
CLSD TX SHOULDER DISLC W/MANIPU W/O ANES
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
8150086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$1,477.25 |
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$1,321.75
|
| Rate for Payer: First Health Commercial |
$1,399.50
|
| Rate for Payer: First Health Workers Compensation |
$600.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,399.50
|
| Rate for Payer: GEHA Commercial |
$1,088.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,399.50
|
| Rate for Payer: Multiplan All |
$1,415.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,088.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,399.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,477.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,166.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,446.15
|
| Rate for Payer: Zelis Auto |
$622.00
|
| Rate for Payer: Zelis Worker's Compensation |
$424.51
|
|
|
CLSD TX SHOULDER DISLC W/MANIPU W/O ANES
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
6123650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: First Health Workers Compensation |
$278.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$649.80
|
| Rate for Payer: GEHA Commercial |
$505.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$649.80
|
| Rate for Payer: Multiplan All |
$657.02
|
| Rate for Payer: OMNI Networks Commercial |
$505.40
|
| Rate for Payer: One Health Plan PPO/POS |
$649.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$685.90
|
| Rate for Payer: Three Rivers Provider Network All |
$541.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$671.46
|
| Rate for Payer: Zelis Auto |
$288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$197.11
|
|
|
CLSD TX SHOULDER DISLC W/MANIPU W/O ANES
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
8150086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,477.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$1,321.75
|
| Rate for Payer: First Health Commercial |
$1,399.50
|
| Rate for Payer: First Health Workers Compensation |
$600.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,399.50
|
| Rate for Payer: GEHA Commercial |
$1,244.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,399.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,415.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,088.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,399.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,477.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,166.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,446.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$622.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$424.51
|
|
|
CLSD TX SHOULDER DISLC W/MANIPU W/O ANES
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
21600194
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: First Health Workers Compensation |
$278.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$649.80
|
| Rate for Payer: GEHA Commercial |
$505.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$649.80
|
| Rate for Payer: Multiplan All |
$657.02
|
| Rate for Payer: OMNI Networks Commercial |
$505.40
|
| Rate for Payer: One Health Plan PPO/POS |
$649.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$685.90
|
| Rate for Payer: Three Rivers Provider Network All |
$541.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$671.46
|
| Rate for Payer: Zelis Auto |
$288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$197.11
|
|
|
CLSD TX SHOULDER DISLC W/MANIPU W/O ANES
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
6123650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$433.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: First Health Workers Compensation |
$278.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$649.80
|
| Rate for Payer: GEHA Commercial |
$577.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$649.80
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$657.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$505.40
|
| Rate for Payer: One Health Plan PPO/POS |
$649.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$685.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$541.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$671.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$288.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$197.11
|
|
|
CLSD TX SHOULDER DISLC W/MANIPU W/O ANES
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
21600194
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$433.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: First Health Workers Compensation |
$278.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$649.80
|
| Rate for Payer: GEHA Commercial |
$577.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$649.80
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$657.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$505.40
|
| Rate for Payer: One Health Plan PPO/POS |
$649.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$685.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$541.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$671.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$288.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$197.11
|
|
|
CLSD TX TEMP DISLOC INIT OR SUB
|
Facility
|
OP
|
$873.00
|
|
| Hospital Charge Code |
8121480
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: First Health Workers Compensation |
$337.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$698.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Humana ChoiceCare |
$226.98
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$523.80
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$768.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$436.50
|
| Rate for Payer: Zelis Worker's Compensation |
$238.33
|
|
|
CLSD TX TEMP DISLOC INIT OR SUB
|
Facility
|
IP
|
$873.00
|
|
| Hospital Charge Code |
8121480
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.33 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: First Health Workers Compensation |
$337.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$611.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
| Rate for Payer: Zelis Worker's Compensation |
$238.33
|
|
|
CL- SHINGRIX 50 MCG / 0.5 ML
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
3350268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$231.23 |
| Max. Negotiated Rate |
$804.65 |
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$719.95
|
| Rate for Payer: First Health Commercial |
$762.30
|
| Rate for Payer: First Health Workers Compensation |
$327.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$762.30
|
| Rate for Payer: GEHA Commercial |
$592.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$762.30
|
| Rate for Payer: Multiplan All |
$770.77
|
| Rate for Payer: OMNI Networks Commercial |
$592.90
|
| Rate for Payer: One Health Plan PPO/POS |
$762.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$804.65
|
| Rate for Payer: Three Rivers Provider Network All |
$635.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$787.71
|
| Rate for Payer: Zelis Auto |
$338.80
|
| Rate for Payer: Zelis Worker's Compensation |
$231.23
|
|
|
CL- SHINGRIX 50 MCG / 0.5 ML
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
3350268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$804.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$719.95
|
| Rate for Payer: First Health Commercial |
$762.30
|
| Rate for Payer: First Health Workers Compensation |
$327.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$762.30
|
| Rate for Payer: GEHA Commercial |
$677.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$762.30
|
| Rate for Payer: Humana ChoiceCare |
$220.22
|
| Rate for Payer: Multiplan All |
$770.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$508.20
|
| Rate for Payer: OMNI Networks Commercial |
$592.90
|
| Rate for Payer: One Health Plan PPO/POS |
$762.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$804.65
|
| Rate for Payer: Three Rivers Provider Network All |
$635.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$745.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$787.71
|
| Rate for Payer: Zelis Auto |
$338.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$423.50
|
| Rate for Payer: Zelis Worker's Compensation |
$231.23
|
|
|
CL- SHINGRIX 50 MGC/ 0.5 ML - PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
3350272
|
|
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- SHINGRIX 50 MGC/ 0.5 ML - PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
3350272
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$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: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- SILVER NITRATE APPLICATOR
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350080
|
|
Hospital Revenue Code
|
250
|
| 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- SILVER NITRATE APPLICATOR
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350080
|
|
Hospital Revenue Code
|
250
|
| 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- SILVER SULFADIAZINE CREAM - 1 APP
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| 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: 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 |
$5.60
|
| 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- SILVER SULFADIAZINE CREAM - 1 APP
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350082
|
|
Hospital Revenue Code
|
250
|
| 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- SILVER SULFADIAZINE CREAM - 400GM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
NDC 00591081046
|
| Hospital Charge Code |
3350081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.71
|
|
|
CL- SILVER SULFADIAZINE CREAM - 400GM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
NDC 00591081046
|
| Hospital Charge Code |
3350081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Humana ChoiceCare |
$70.20
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.00
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$237.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.71
|
|
|
CL- SODIUM BICARB INJ 4.2%- NEUT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: First Health Workers Compensation |
$9.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: Zelis Auto |
$9.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.55
|
|
