|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9627816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.03 |
| Max. Negotiated Rate |
$1,064.95 |
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: First Health Workers Compensation |
$432.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,008.90
|
| Rate for Payer: GEHA Commercial |
$784.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,008.90
|
| Rate for Payer: Multiplan All |
$1,020.11
|
| Rate for Payer: OMNI Networks Commercial |
$784.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,008.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,064.95
|
| Rate for Payer: Three Rivers Provider Network All |
$840.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,042.53
|
| Rate for Payer: Zelis Auto |
$448.40
|
| Rate for Payer: Zelis Worker's Compensation |
$306.03
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
8727816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$907.25 |
| 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 |
$573.00
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| 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 |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| 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 |
$907.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| 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 |
$888.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CL- VINBLASTINE SULFATE 1 MG
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
3350363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CL- VINBLASTINE SULFATE 1 MG
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
3350363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$5.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CL- VINCRISTINE 1 MG/ML
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
3350364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$9.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
CL- VINCRISTINE 1 MG/ML
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
3350364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
CL- VITAMINS A & D OINT
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00168003501
|
| Hospital Charge Code |
3350091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
CL- VITAMINS A & D OINT
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00168003501
|
| Hospital Charge Code |
3350091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
CL- VIT.B-12 1000MCG INJ. - PTS. OWN MED
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
3350155
|
|
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- VIT.B-12 1000MCG INJ. - PTS. OWN MED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
3350155
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$1.11 |
| 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 |
$1.11
|
| 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- WATER - BACTERIOSTATIC
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
3350092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CL- WATER - BACTERIOSTATIC
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 00409397703
|
| Hospital Charge Code |
3350092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CL- WATER FOR INJECTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
3350093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
CL- WATER FOR INJECTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
3350093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
CL- XEOMIN 100 UNIT VIAL
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J0588
|
| Hospital Charge Code |
3350196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CL- XEOMIN 100 UNIT VIAL
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J0588
|
| Hospital Charge Code |
3350196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$6.13
|
| Rate for Payer: GEHA Medicare |
$5.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$6.13
|
| Rate for Payer: Humana Medicare Advantage |
$5.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.57
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.47
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.14
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.57
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Medicare |
$4.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.68
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CL- XEOMIN 50 UNITS
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J0588
|
| Hospital Charge Code |
3350195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CL- XEOMIN 50 UNITS
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J0588
|
| Hospital Charge Code |
3350195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$6.13
|
| Rate for Payer: GEHA Medicare |
$5.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$6.13
|
| Rate for Payer: Humana Medicare Advantage |
$5.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.57
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.47
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.14
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.57
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Medicare |
$4.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.68
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CL- XIAFLEX FOR INJ 0.9 MG
|
Facility
|
IP
|
$10,905.00
|
|
|
Service Code
|
CPT J0775
|
| Hospital Charge Code |
3350025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,977.07 |
| Max. Negotiated Rate |
$10,359.75 |
| Rate for Payer: Cash Price |
$6,543.00
|
| Rate for Payer: Cigna Commercial |
$9,269.25
|
| Rate for Payer: First Health Commercial |
$9,814.50
|
| Rate for Payer: First Health Workers Compensation |
$4,210.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,814.50
|
| Rate for Payer: GEHA Commercial |
$7,633.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,814.50
|
| Rate for Payer: Multiplan All |
$9,923.55
|
| Rate for Payer: OMNI Networks Commercial |
$7,633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$9,814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,359.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,178.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,141.65
|
| Rate for Payer: Zelis Auto |
$4,362.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,977.07
|
|
|
CL- XIAFLEX FOR INJ 0.9 MG
|
Facility
|
OP
|
$10,905.00
|
|
|
Service Code
|
CPT J0775
|
| Hospital Charge Code |
3350025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$10,359.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,543.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$75.91
|
| Rate for Payer: Cash Price |
$6,543.00
|
| Rate for Payer: Cash Price |
$6,543.00
|
| Rate for Payer: Cigna Commercial |
$9,269.25
|
| Rate for Payer: First Health Commercial |
$9,814.50
|
| Rate for Payer: First Health Workers Compensation |
$4,210.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,814.50
|
| Rate for Payer: GEHA Commercial |
$83.50
|
| Rate for Payer: GEHA Medicare |
$75.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,814.50
|
| Rate for Payer: Humana ChoiceCare |
$83.50
|
| Rate for Payer: Humana Medicare Advantage |
$75.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$127.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$75.91
|
| Rate for Payer: Multiplan All |
$9,923.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.05
|
| Rate for Payer: OMNI Networks Commercial |
$7,633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$9,814.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$53.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$75.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,359.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$151.82
|
| Rate for Payer: Three Rivers Provider Network All |
$8,178.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$74.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,141.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$75.91
|
| Rate for Payer: Zelis Auto |
$4,362.00
|
| Rate for Payer: Zelis Medicare |
$64.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.09
|
| Rate for Payer: Zelis Worker's Compensation |
$2,977.07
|
|
|
CL- ZILRETTA 32 MG ER INJ *** PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J3304
|
| Hospital Charge Code |
3350253
|
|
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- ZILRETTA 32 MG ER INJ *** PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J3304
|
| Hospital Charge Code |
3350253
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.51
|
| 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 |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.30
|
| 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 |
$20.13
|
| Rate for Payer: GEHA Medicare |
$18.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$20.13
|
| Rate for Payer: Humana Medicare Advantage |
$18.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.30
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.11
|
| 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 |
$28.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.60
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.30
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$15.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.96
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
CL- ZILRETTA 32 MG ER, INJ SUSPN
|
Facility
|
IP
|
$2,497.00
|
|
|
Service Code
|
CPT J3304
|
| Hospital Charge Code |
3350252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$681.68 |
| Max. Negotiated Rate |
$2,372.15 |
| Rate for Payer: Cash Price |
$1,498.20
|
| Rate for Payer: Cigna Commercial |
$2,122.45
|
| Rate for Payer: First Health Commercial |
$2,247.30
|
| Rate for Payer: First Health Workers Compensation |
$964.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,247.30
|
| Rate for Payer: GEHA Commercial |
$1,747.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,247.30
|
| Rate for Payer: Multiplan All |
$2,272.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,247.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,372.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,322.21
|
| Rate for Payer: Zelis Auto |
$998.80
|
| Rate for Payer: Zelis Worker's Compensation |
$681.68
|
|
|
CL- ZILRETTA 32 MG ER, INJ SUSPN
|
Facility
|
OP
|
$2,497.00
|
|
|
Service Code
|
CPT J3304
|
| Hospital Charge Code |
3350252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$2,372.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,498.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.30
|
| Rate for Payer: Cash Price |
$1,498.20
|
| Rate for Payer: Cash Price |
$1,498.20
|
| Rate for Payer: Cigna Commercial |
$2,122.45
|
| Rate for Payer: First Health Commercial |
$2,247.30
|
| Rate for Payer: First Health Workers Compensation |
$964.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,247.30
|
| Rate for Payer: GEHA Commercial |
$20.13
|
| Rate for Payer: GEHA Medicare |
$18.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,247.30
|
| Rate for Payer: Humana ChoiceCare |
$20.13
|
| Rate for Payer: Humana Medicare Advantage |
$18.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.30
|
| Rate for Payer: Multiplan All |
$2,272.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,247.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.66
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,372.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,322.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.30
|
| Rate for Payer: Zelis Auto |
$998.80
|
| Rate for Payer: Zelis Medicare |
$15.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.96
|
| Rate for Payer: Zelis Worker's Compensation |
$681.68
|
|
|
CL- ZIPRASIDONE 20MG IM INJ (PT OWN MED)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J3486
|
| Hospital Charge Code |
3350488
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$7.51 |
| 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 |
$7.51
|
| 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
|
|
