|
CONT GLUC MNTR PHYS/QHP PROVIDED EQUIP
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
8595250
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$301.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
CONT GLUC MONITOR PATIENT PROVIDED EQUIP
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
8595249
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$136.85
|
| Rate for Payer: First Health Commercial |
$144.90
|
| Rate for Payer: First Health Workers Compensation |
$62.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.90
|
| Rate for Payer: GEHA Commercial |
$112.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.90
|
| Rate for Payer: Multiplan All |
$146.51
|
| Rate for Payer: OMNI Networks Commercial |
$112.70
|
| Rate for Payer: One Health Plan PPO/POS |
$144.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.95
|
| Rate for Payer: Three Rivers Provider Network All |
$120.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$149.73
|
| Rate for Payer: Zelis Auto |
$64.40
|
| Rate for Payer: Zelis Worker's Compensation |
$43.95
|
|
|
CONT GLUC MONITOR PATIENT PROVIDED EQUIP
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
8595249
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$136.85
|
| Rate for Payer: First Health Commercial |
$144.90
|
| Rate for Payer: First Health Workers Compensation |
$62.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.90
|
| Rate for Payer: GEHA Commercial |
$128.80
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.90
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$146.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$112.70
|
| Rate for Payer: One Health Plan PPO/POS |
$144.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$120.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$149.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$64.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$43.95
|
|
|
CONTINUOUS NEGATIVE PRESSURE INITIATION/
|
Facility
|
OP
|
$1,582.00
|
|
|
Service Code
|
CPT 94662
|
| Hospital Charge Code |
4094662
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$1,502.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$293.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$949.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$293.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$232.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$627.74
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cigna Commercial |
$1,344.70
|
| Rate for Payer: First Health Commercial |
$1,423.80
|
| Rate for Payer: First Health Workers Compensation |
$610.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,423.80
|
| Rate for Payer: GEHA Commercial |
$1,265.60
|
| Rate for Payer: GEHA Medicare |
$627.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,423.80
|
| Rate for Payer: Humana ChoiceCare |
$690.51
|
| Rate for Payer: Humana Medicare Advantage |
$627.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,054.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$237.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$627.74
|
| Rate for Payer: Multiplan All |
$1,439.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,067.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,107.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,423.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$274.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$237.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$627.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,502.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,255.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,186.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$615.19
|
| Rate for Payer: United Healthcare Commercial |
$1,344.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$237.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$627.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,471.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$627.74
|
| Rate for Payer: Zelis Auto |
$632.80
|
| Rate for Payer: Zelis Medicare |
$533.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$753.29
|
| Rate for Payer: Zelis Worker's Compensation |
$431.89
|
|
|
CONTINUOUS NEGATIVE PRESSURE INITIATION/
|
Facility
|
IP
|
$1,582.00
|
|
|
Service Code
|
CPT 94662
|
| Hospital Charge Code |
4094662
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$431.89 |
| Max. Negotiated Rate |
$1,502.90 |
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cigna Commercial |
$1,344.70
|
| Rate for Payer: First Health Commercial |
$1,423.80
|
| Rate for Payer: First Health Workers Compensation |
$610.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,423.80
|
| Rate for Payer: GEHA Commercial |
$1,107.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,423.80
|
| Rate for Payer: Multiplan All |
$1,439.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,107.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,423.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,502.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,186.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,471.26
|
| Rate for Payer: Zelis Auto |
$632.80
|
| Rate for Payer: Zelis Worker's Compensation |
$431.89
|
|
|
CONTOUR OF FACE BONE LESION
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
CPT 21029
|
| Hospital Charge Code |
6121029
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.45 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$1,106.70
|
| Rate for Payer: First Health Commercial |
$1,171.80
|
| Rate for Payer: First Health Workers Compensation |
$502.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,171.80
|
| Rate for Payer: GEHA Commercial |
$911.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,171.80
|
| Rate for Payer: Multiplan All |
$1,184.82
|
| Rate for Payer: OMNI Networks Commercial |
$911.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,171.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,236.90
|
| Rate for Payer: Three Rivers Provider Network All |
$976.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,210.86
|
| Rate for Payer: Zelis Auto |
$520.80
|
| Rate for Payer: Zelis Worker's Compensation |
$355.45
|
|
|
CONTOUR OF FACE BONE LESION
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
CPT 21029
|
| Hospital Charge Code |
6121029
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.45 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$781.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$1,106.70
|
| Rate for Payer: First Health Commercial |
$1,171.80
|
| Rate for Payer: First Health Workers Compensation |
$502.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,171.80
|
| Rate for Payer: GEHA Commercial |
$1,041.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,171.80
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,184.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$911.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,171.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,236.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$976.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,210.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$520.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$355.45
|
|
|
CONTRAST LOW OSMOLAR
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
2401000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CONTRAST LOW OSMOLAR
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
2401000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$0.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
CONTROL GEL FORMULA - DRESSING 4X4
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
NDC 00003187955
|
| Hospital Charge Code |
3300207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$25.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
CONTROL GEL FORMULA - DRESSING 4X4
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
NDC 00003187955
|
| Hospital Charge Code |
3300207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Humana ChoiceCare |
$9.62
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.20
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
CONTROL GEL FORMULA - DRESSING 8X8
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
NDC 00003187957
|
| Hospital Charge Code |
3300208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$13.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.00
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
CONTROL GEL FORMULA - DRESSING 8X8
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
NDC 00003187957
|
| Hospital Charge Code |
3300208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
CONTROLLER NEUROSTIMULATOR INTELLIS
|
Facility
|
OP
|
$4,415.00
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
7003155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.75 |
| Max. Negotiated Rate |
$4,194.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$3,752.75
|
| Rate for Payer: First Health Commercial |
$3,973.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,973.50
|
| Rate for Payer: GEHA Commercial |
$3,532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,973.50
|
| Rate for Payer: Humana ChoiceCare |
$1,147.90
|
| Rate for Payer: Multiplan All |
$4,017.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,649.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,090.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,973.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,194.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,885.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,103.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,105.95
|
| Rate for Payer: Zelis Auto |
$1,766.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,207.50
|
|
|
CONTROLLER NEUROSTIMULATOR INTELLIS
|
Facility
|
IP
|
$4,415.00
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
7003155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.00 |
| Max. Negotiated Rate |
$4,194.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,532.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$3,752.75
|
| Rate for Payer: First Health Commercial |
$3,973.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,973.50
|
| Rate for Payer: GEHA Commercial |
$3,090.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,973.50
|
| Rate for Payer: Multiplan All |
$4,017.65
|
| Rate for Payer: OMNI Networks Commercial |
$3,090.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,973.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,194.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,105.95
|
| Rate for Payer: Zelis Auto |
$1,766.00
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
6130903
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$391.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$251.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$521.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
21600230
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$251.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$456.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE
|
Facility
|
OP
|
$343.00
|
|
| Hospital Charge Code |
8150066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Humana ChoiceCare |
$89.18
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$205.80
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$301.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$171.50
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
21600230
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$391.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$251.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$521.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE
|
Facility
|
IP
|
$343.00
|
|
| Hospital Charge Code |
8150066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$240.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLE
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
6130903
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$251.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$456.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
21600229
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
8130901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
10030901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$611.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
8300043
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
