|
CL- TICE BCG 50MG
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT J9030
|
| Hospital Charge Code |
3350104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
CL- TICE BCG 50MG
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT J9030
|
| Hospital Charge Code |
3350104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.35
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$3.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Humana ChoiceCare |
$231.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.42
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$533.40
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$782.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.50
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
CL- TINCTURE OF BENZOIN SPRAY
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
NDC 40565011182
|
| Hospital Charge Code |
3350483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$178.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
CL- TINCTURE OF BENZOIN SPRAY
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
NDC 40565011182
|
| Hospital Charge Code |
3350483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$204.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Humana ChoiceCare |
$66.30
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.00
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.50
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
CL- TOBRAMYCIN-DEXAMETH OPTH SUSP
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
NDC 00574403125
|
| Hospital Charge Code |
3350535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
CL- TOBRAMYCIN-DEXAMETH OPTH SUSP
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
NDC 00574403125
|
| Hospital Charge Code |
3350535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
CL- TRASTUZUMAB 10 MG
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
3350312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
CL- TRASTUZUMAB 10 MG
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
3350312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$127.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$127.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$75.03
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$82.53
|
| Rate for Payer: GEHA Medicare |
$75.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$82.53
|
| Rate for Payer: Humana Medicare Advantage |
$75.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$126.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$75.03
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.55
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$119.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$103.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$75.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$150.06
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.53
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$75.03
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Medicare |
$63.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.04
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
CL- Triamcinolone 10 mg/ ml
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
3350266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$19.55
|
| Rate for Payer: First Health Commercial |
$20.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20.70
|
| Rate for Payer: GEHA Commercial |
$0.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20.70
|
| Rate for Payer: Humana ChoiceCare |
$5.98
|
| Rate for Payer: Multiplan All |
$20.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.80
|
| Rate for Payer: OMNI Networks Commercial |
$16.10
|
| Rate for Payer: One Health Plan PPO/POS |
$20.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21.85
|
| Rate for Payer: Three Rivers Provider Network All |
$17.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$21.39
|
| Rate for Payer: Zelis Auto |
$9.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
CL- Triamcinolone 10 mg/ ml
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
3350266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$19.55
|
| Rate for Payer: First Health Commercial |
$20.70
|
| Rate for Payer: First Health Workers Compensation |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20.70
|
| Rate for Payer: GEHA Commercial |
$16.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20.70
|
| Rate for Payer: Multiplan All |
$20.93
|
| Rate for Payer: OMNI Networks Commercial |
$16.10
|
| Rate for Payer: One Health Plan PPO/POS |
$20.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21.85
|
| Rate for Payer: Three Rivers Provider Network All |
$17.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$21.39
|
| Rate for Payer: Zelis Auto |
$9.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
CL- TRIAMCINOLONE CREAM 0.1% 15GM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
NDC 00168000415
|
| Hospital Charge Code |
3350097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$31.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$10.14
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.40
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
CL- TRIAMCINOLONE CREAM 0.1% 15GM
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
NDC 00168000415
|
| Hospital Charge Code |
3350097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$27.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
CL- TRIPLE ANTIBIOTIC 28.4GM TUBE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 00713026831
|
| Hospital Charge Code |
3350065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CL- TRIPLE ANTIBIOTIC 28.4GM TUBE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 00713026831
|
| Hospital Charge Code |
3350065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CL- TRIPLE ANTIBIOTIC PACKET
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 00168001209
|
| Hospital Charge Code |
3350108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CL- TRIPLE ANTIBIOTIC PACKET
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00168001209
|
| Hospital Charge Code |
3350108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CL- TRIPLE ANTIBIOTIC UD PACKET
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CL- TRIPLE ANTIBIOTIC UD PACKET
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3350064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CL- TUBERCULIN PPD - HOSPITAL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3350115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.66
|
| 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 |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.73
|
| 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 |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: GEHA Medicare |
$23.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$26.10
|
| Rate for Payer: Humana Medicare Advantage |
$23.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.73
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.34
|
| 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 |
$15.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$47.46
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.26
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.73
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$20.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.48
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
CL- TUBERCULIN PPD - HOSPITAL
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3350115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$34.20 |
| 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 |
$11.86
|
| 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 |
$8.39
|
|
|
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
8127842
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$999.18 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: First Health Workers Compensation |
$1,413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,928.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$999.18
|
|
|
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
6127842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$999.18 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: First Health Workers Compensation |
$1,413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,562.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$999.18
|
|
|
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
6127842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$999.18 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: First Health Workers Compensation |
$1,413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,928.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$999.18
|
|
|
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
8127842
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$999.18 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: First Health Workers Compensation |
$1,413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,562.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$999.18
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
6126740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$510.15 |
| 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 |
$322.20
|
| 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 |
$232.44
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$429.60
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| 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 |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
