|
CL- SYNVISC 8MG/ML INJ
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$284.74 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cigna Commercial |
$886.55
|
| Rate for Payer: First Health Commercial |
$938.70
|
| Rate for Payer: First Health Workers Compensation |
$402.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$938.70
|
| Rate for Payer: GEHA Commercial |
$730.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$938.70
|
| Rate for Payer: Multiplan All |
$949.13
|
| Rate for Payer: OMNI Networks Commercial |
$730.10
|
| Rate for Payer: One Health Plan PPO/POS |
$938.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$990.85
|
| Rate for Payer: Three Rivers Provider Network All |
$782.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$969.99
|
| Rate for Payer: Zelis Auto |
$417.20
|
| Rate for Payer: Zelis Worker's Compensation |
$284.74
|
|
|
CL- SYNVISC 8MG/ML INJ
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$625.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cigna Commercial |
$886.55
|
| Rate for Payer: First Health Commercial |
$938.70
|
| Rate for Payer: First Health Workers Compensation |
$402.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$938.70
|
| Rate for Payer: GEHA Commercial |
$8.74
|
| Rate for Payer: GEHA Medicare |
$7.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$938.70
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.95
|
| Rate for Payer: Multiplan All |
$949.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.52
|
| Rate for Payer: OMNI Networks Commercial |
$730.10
|
| Rate for Payer: One Health Plan PPO/POS |
$938.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$990.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.90
|
| Rate for Payer: Three Rivers Provider Network All |
$782.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$969.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.95
|
| Rate for Payer: Zelis Auto |
$417.20
|
| Rate for Payer: Zelis Medicare |
$6.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.54
|
| Rate for Payer: Zelis Worker's Compensation |
$284.74
|
|
|
CL- SYNVISC 8MG/ML INJ - PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350235
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$18.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.99
|
| 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 |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.95
|
| 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 |
$8.74
|
| Rate for Payer: GEHA Medicare |
$7.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.95
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.52
|
| 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 |
$17.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.90
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.95
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$6.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.54
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- SYNVISC 8MG/ML INJ - PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350235
|
|
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- SYNVISC ONE 8MG/ML INJ
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$2,417.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,527.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cigna Commercial |
$2,163.25
|
| Rate for Payer: First Health Commercial |
$2,290.50
|
| Rate for Payer: First Health Workers Compensation |
$982.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,290.50
|
| Rate for Payer: GEHA Commercial |
$8.74
|
| Rate for Payer: GEHA Medicare |
$7.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,290.50
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.95
|
| Rate for Payer: Multiplan All |
$2,315.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,781.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,290.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,417.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,366.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.95
|
| Rate for Payer: Zelis Auto |
$1,018.00
|
| Rate for Payer: Zelis Medicare |
$6.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.54
|
| Rate for Payer: Zelis Worker's Compensation |
$694.78
|
|
|
CL- SYNVISC ONE 8MG/ML INJ
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$694.78 |
| Max. Negotiated Rate |
$2,417.75 |
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cigna Commercial |
$2,163.25
|
| Rate for Payer: First Health Commercial |
$2,290.50
|
| Rate for Payer: First Health Workers Compensation |
$982.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,290.50
|
| Rate for Payer: GEHA Commercial |
$1,781.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,290.50
|
| Rate for Payer: Multiplan All |
$2,315.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,781.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,290.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,417.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,366.85
|
| Rate for Payer: Zelis Auto |
$1,018.00
|
| Rate for Payer: Zelis Worker's Compensation |
$694.78
|
|
|
CL- SYNVISC ONE 8MG/ML INJ - PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350236
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$18.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.99
|
| 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 |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.95
|
| 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 |
$8.74
|
| Rate for Payer: GEHA Medicare |
$7.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.95
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.52
|
| 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 |
$17.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.90
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.95
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$6.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.54
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- SYNVISC ONE 8MG/ML INJ - PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3350236
|
|
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- Tdap 0.5ML - Floorstock
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
3350088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$86.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$43.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Humana ChoiceCare |
$58.24
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$134.40
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$197.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
|
CL- Tdap 0.5ML - Floorstock
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
3350088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$86.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
|
CL- TERIPARATIDE 620 MCG/2.48 ML PT-OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J3110
|
| Hospital Charge Code |
335415
|
|
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- TESTOSTERONE 100MG/ML INJ PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
3350558
|
|
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- TESTOSTERONE 100MG/ML INJ PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
3350558
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.03 |
| 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: 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 |
$0.03
|
| 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- TESTOSTERONE 200MG/ML INJ(PT. OWN)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
3350143
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.03 |
| 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: 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 |
$0.03
|
| 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- TESTOSTERONE 200MG/ML INJ(PT. OWN)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
3350143
|
|
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- TETANUS and DIPHTHERIA- floorstock
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
3350192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$67.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.05
|
|
|
CL- TETANUS and DIPHTHERIA- floorstock
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
3350192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$67.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$41.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Humana ChoiceCare |
$45.76
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.60
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$154.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$88.00
|
| Rate for Payer: Zelis Worker's Compensation |
$48.05
|
|
|
CL- Tetanus/Diphtheria toxoid (Td)
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
3350089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$41.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
CL- Tetanus/Diphtheria toxoid (Td)
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
3350089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
CL- TETRACAINE HCL OPTH SOLN 0.5%
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
CL- TETRACAINE HCL OPTH SOLN 0.5%
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
CL- THYROGEN 0.9 MG
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
3350243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,590.22 |
| Max. Negotiated Rate |
$5,533.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,687.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,116.32
|
| Rate for Payer: Cash Price |
$3,495.00
|
| Rate for Payer: Cash Price |
$3,495.00
|
| Rate for Payer: Cigna Commercial |
$4,951.25
|
| Rate for Payer: First Health Commercial |
$5,242.50
|
| Rate for Payer: First Health Workers Compensation |
$2,249.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,242.50
|
| Rate for Payer: GEHA Commercial |
$2,327.95
|
| Rate for Payer: GEHA Medicare |
$2,116.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,242.50
|
| Rate for Payer: Humana ChoiceCare |
$2,327.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,116.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,555.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,722.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,116.32
|
| Rate for Payer: Multiplan All |
$5,300.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,597.74
|
| Rate for Payer: OMNI Networks Commercial |
$4,077.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,242.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,988.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,722.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,116.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,533.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4,232.64
|
| Rate for Payer: Three Rivers Provider Network All |
$4,368.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,073.99
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,722.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,116.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,417.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,116.32
|
| Rate for Payer: Zelis Auto |
$2,330.00
|
| Rate for Payer: Zelis Medicare |
$1,798.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,539.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,590.22
|
|
|
CL- THYROGEN 0.9 MG
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
3350243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,590.22 |
| Max. Negotiated Rate |
$5,533.75 |
| Rate for Payer: Cash Price |
$3,495.00
|
| Rate for Payer: Cigna Commercial |
$4,951.25
|
| Rate for Payer: First Health Commercial |
$5,242.50
|
| Rate for Payer: First Health Workers Compensation |
$2,249.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,242.50
|
| Rate for Payer: GEHA Commercial |
$4,077.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,242.50
|
| Rate for Payer: Multiplan All |
$5,300.75
|
| Rate for Payer: OMNI Networks Commercial |
$4,077.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,242.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,533.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,368.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,417.25
|
| Rate for Payer: Zelis Auto |
$2,330.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,590.22
|
|
|
CL- THYROGEN 0.9 MG *** PT OWN MED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
3350244
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$4,232.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,130.66
|
| 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 |
$2,130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,687.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,116.32
|
| 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 |
$2,327.95
|
| Rate for Payer: GEHA Medicare |
$2,116.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$2,327.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,116.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,555.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,722.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,116.32
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,597.74
|
| 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 |
$1,988.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,722.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,116.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4,232.64
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,073.99
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,722.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,116.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,116.32
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$1,798.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,539.58
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- THYROGEN 0.9 MG *** PT OWN MED
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
3350244
|
|
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
|
|
