|
DIABETIC SNACK MISC
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
3300242
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
DIABETIC SNACK MISC
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
3300242
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
DIAB MANAGE TRN PER INDIV
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
9199506
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
DIAB MANAGE TRN PER INDIV
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
9199506
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.68
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$42.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.94
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.20
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$72.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.00
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
6138220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$313.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$313.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$248.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$156.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$253.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$292.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$253.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
6138220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$136.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRA
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
6169670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$170.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRA
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
6169670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,021.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,021.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,601.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$194.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,634.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,887.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,634.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,634.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
DIAGNOSTIC COLONOSCOPY
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
6145378
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.62 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$355.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$228.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$473.60
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$161.62
|
|
|
DIAGNOSTIC COLONOSCOPY
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
6145378
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.62 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$228.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Worker's Compensation |
$161.62
|
|
|
DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
6131579
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: First Health Workers Compensation |
$168.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$305.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Worker's Compensation |
$119.30
|
|
|
DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
6131579
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$737.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$446.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$446.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$353.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$368.72
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: First Health Workers Compensation |
$168.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$349.60
|
| Rate for Payer: GEHA Medicare |
$368.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Humana ChoiceCare |
$405.59
|
| Rate for Payer: Humana Medicare Advantage |
$368.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$619.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$368.72
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$626.82
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$416.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$368.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$737.44
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$368.72
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Medicare |
$313.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.46
|
| Rate for Payer: Zelis Worker's Compensation |
$119.30
|
|
|
DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
6131505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$368.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$80.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$80.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$184.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$184.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$202.77
|
| Rate for Payer: Humana Medicare Advantage |
$184.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$309.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$65.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$184.34
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$313.38
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$184.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$368.68
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$180.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$184.34
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$156.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.21
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
6131505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
DIALYSIS CIRCUIT EMBOL
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
6191055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$583.20
|
| Rate for Payer: First Health Workers Compensation |
$250.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$583.20
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$583.20
|
| Rate for Payer: Multiplan All |
$589.68
|
| Rate for Payer: OMNI Networks Commercial |
$453.60
|
| Rate for Payer: One Health Plan PPO/POS |
$583.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.60
|
| Rate for Payer: Three Rivers Provider Network All |
$486.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.64
|
| Rate for Payer: Zelis Auto |
$259.20
|
| Rate for Payer: Zelis Worker's Compensation |
$176.90
|
|
|
DIALYSIS CIRCUIT EMBOL
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
6191055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$583.20
|
| Rate for Payer: First Health Workers Compensation |
$250.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$583.20
|
| Rate for Payer: GEHA Commercial |
$518.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$583.20
|
| Rate for Payer: Humana ChoiceCare |
$168.48
|
| Rate for Payer: Multiplan All |
$589.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$388.80
|
| Rate for Payer: OMNI Networks Commercial |
$453.60
|
| Rate for Payer: One Health Plan PPO/POS |
$583.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.60
|
| Rate for Payer: Three Rivers Provider Network All |
$486.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$570.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$162.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.64
|
| Rate for Payer: Zelis Auto |
$259.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$324.00
|
| Rate for Payer: Zelis Worker's Compensation |
$176.90
|
|
|
DIATRIZOATE MEGLUMINE INJ 18%
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT Q9958
|
| Hospital Charge Code |
3300244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$0.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$160.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
DIATRIZOATE MEGLUMINE INJ 18%
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT Q9958
|
| Hospital Charge Code |
3300244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
DIAZEPAM 5MG/ML 10ML VIAL
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
3302729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$188.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
DIAZEPAM 5MG/ML 10ML VIAL
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
3302729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$8.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Humana ChoiceCare |
$69.94
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$161.40
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$236.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.50
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
DIAZEPAM INJ 10 MG/2 ML
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
3300245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
DIAZEPAM INJ 10 MG/2 ML
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
3300245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$8.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
DIAZEPAM TAB 5MG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
3300247
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$8.09 |
| 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: 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 |
$8.09
|
| 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
|
|
|
DIAZEPAM TAB 5MG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
3300247
|
|
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
|
|
|
DIBUCAINE OINTMENT 1%
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
NDC 00536121195
|
| Hospital Charge Code |
3305025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$48.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Humana ChoiceCare |
$15.86
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$53.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
