|
DRAIN CHEST LESION
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 21502
|
| Hospital Charge Code |
6121502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cigna Commercial |
$936.70
|
| Rate for Payer: First Health Commercial |
$991.80
|
| Rate for Payer: First Health Workers Compensation |
$425.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$991.80
|
| Rate for Payer: GEHA Commercial |
$771.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$991.80
|
| Rate for Payer: Multiplan All |
$1,002.82
|
| Rate for Payer: OMNI Networks Commercial |
$771.40
|
| Rate for Payer: One Health Plan PPO/POS |
$991.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,046.90
|
| Rate for Payer: Three Rivers Provider Network All |
$826.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,024.86
|
| Rate for Payer: Zelis Auto |
$440.80
|
| Rate for Payer: Zelis Worker's Compensation |
$300.85
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6169000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: First Health Workers Compensation |
$139.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.90
|
| Rate for Payer: GEHA Commercial |
$252.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.90
|
| Rate for Payer: Multiplan All |
$328.51
|
| Rate for Payer: OMNI Networks Commercial |
$252.70
|
| Rate for Payer: One Health Plan PPO/POS |
$324.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.95
|
| Rate for Payer: Three Rivers Provider Network All |
$270.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$335.73
|
| Rate for Payer: Zelis Auto |
$144.40
|
| Rate for Payer: Zelis Worker's Compensation |
$98.55
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6169005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6169000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$1,363.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$681.76
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: First Health Workers Compensation |
$139.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.90
|
| Rate for Payer: GEHA Commercial |
$288.80
|
| Rate for Payer: GEHA Medicare |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.90
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$328.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| Rate for Payer: OMNI Networks Commercial |
$252.70
|
| Rate for Payer: One Health Plan PPO/POS |
$324.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$270.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$335.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$144.40
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| Rate for Payer: Zelis Worker's Compensation |
$98.55
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6169005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
DRAING ABSC/CYST/HEM MOUTH;SMPL
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
8140800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.75 |
| Max. Negotiated Rate |
$1,044.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$934.15
|
| Rate for Payer: First Health Commercial |
$989.10
|
| Rate for Payer: First Health Workers Compensation |
$424.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$989.10
|
| Rate for Payer: GEHA Commercial |
$879.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$989.10
|
| Rate for Payer: Humana ChoiceCare |
$285.74
|
| Rate for Payer: Multiplan All |
$1,000.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$659.40
|
| Rate for Payer: OMNI Networks Commercial |
$769.30
|
| Rate for Payer: One Health Plan PPO/POS |
$989.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,044.05
|
| Rate for Payer: Three Rivers Provider Network All |
$824.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$967.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$274.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,022.07
|
| Rate for Payer: Zelis Auto |
$439.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$549.50
|
| Rate for Payer: Zelis Worker's Compensation |
$300.03
|
|
|
DRAING ABSC/CYST/HEM MOUTH;SMPL
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
8140800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.03 |
| Max. Negotiated Rate |
$1,044.05 |
| Rate for Payer: Cigna Commercial |
$934.15
|
| Rate for Payer: First Health Commercial |
$989.10
|
| Rate for Payer: First Health Workers Compensation |
$424.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$989.10
|
| Rate for Payer: GEHA Commercial |
$769.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$989.10
|
| Rate for Payer: Multiplan All |
$1,000.09
|
| Rate for Payer: OMNI Networks Commercial |
$769.30
|
| Rate for Payer: One Health Plan PPO/POS |
$989.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,044.05
|
| Rate for Payer: Three Rivers Provider Network All |
$824.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,022.07
|
| Rate for Payer: Zelis Auto |
$439.60
|
| Rate for Payer: Zelis Worker's Compensation |
$300.03
|
| Rate for Payer: Cash Price |
$659.40
|
|
|
DRAING ABSC DENTOALVEOLAR
|
Facility
|
IP
|
$726.00
|
|
| Hospital Charge Code |
8141800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.20 |
| Max. Negotiated Rate |
$689.70 |
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$617.10
|
| Rate for Payer: First Health Commercial |
$653.40
|
| Rate for Payer: First Health Workers Compensation |
$280.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$653.40
|
| Rate for Payer: GEHA Commercial |
$508.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$653.40
|
| Rate for Payer: Multiplan All |
$660.66
|
| Rate for Payer: OMNI Networks Commercial |
$508.20
|
| Rate for Payer: One Health Plan PPO/POS |
$653.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$689.70
|
| Rate for Payer: Three Rivers Provider Network All |
$544.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$675.18
|
| Rate for Payer: Zelis Auto |
$290.40
|
| Rate for Payer: Zelis Worker's Compensation |
$198.20
|
|
|
DRAING ABSC DENTOALVEOLAR
|
Facility
|
OP
|
$726.00
|
|
| Hospital Charge Code |
8141800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$689.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$435.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$617.10
|
| Rate for Payer: First Health Commercial |
$653.40
|
| Rate for Payer: First Health Workers Compensation |
$280.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$653.40
|
| Rate for Payer: GEHA Commercial |
$580.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$653.40
|
| Rate for Payer: Humana ChoiceCare |
$188.76
|
| Rate for Payer: Multiplan All |
$660.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$435.60
|
| Rate for Payer: OMNI Networks Commercial |
$508.20
|
| Rate for Payer: One Health Plan PPO/POS |
$653.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$689.70
|
| Rate for Payer: Three Rivers Provider Network All |
$544.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$638.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$675.18
|
| Rate for Payer: Zelis Auto |
$290.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$363.00
|
| Rate for Payer: Zelis Worker's Compensation |
$198.20
|
|
|
DRAING ABSC PALATE/UVULA
|
Facility
|
OP
|
$1,275.00
|
|
| Hospital Charge Code |
8142000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,083.75
|
| Rate for Payer: First Health Commercial |
$1,147.50
|
| Rate for Payer: First Health Workers Compensation |
$492.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,147.50
|
| Rate for Payer: GEHA Commercial |
$1,020.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,147.50
|
| Rate for Payer: Humana ChoiceCare |
$331.50
|
| Rate for Payer: Multiplan All |
$1,160.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$765.00
|
| Rate for Payer: OMNI Networks Commercial |
$892.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,147.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,211.25
|
| Rate for Payer: Three Rivers Provider Network All |
$956.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,122.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$318.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,185.75
|
| Rate for Payer: Zelis Auto |
$510.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$637.50
|
| Rate for Payer: Zelis Worker's Compensation |
$348.07
|
|
|
DRAING ABSC PALATE/UVULA
|
Facility
|
IP
|
$1,275.00
|
|
| Hospital Charge Code |
8142000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.07 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,083.75
|
| Rate for Payer: First Health Commercial |
$1,147.50
|
| Rate for Payer: First Health Workers Compensation |
$492.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,147.50
|
| Rate for Payer: GEHA Commercial |
$892.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,147.50
|
| Rate for Payer: Multiplan All |
$1,160.25
|
| Rate for Payer: OMNI Networks Commercial |
$892.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,147.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,211.25
|
| Rate for Payer: Three Rivers Provider Network All |
$956.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,185.75
|
| Rate for Payer: Zelis Auto |
$510.00
|
| Rate for Payer: Zelis Worker's Compensation |
$348.07
|
|
|
DRAING FINGER ABSC;CMPX
|
Facility
|
IP
|
$3,429.00
|
|
| Hospital Charge Code |
8126011
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.12 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$1,323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,400.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$936.12
|
|
|
DRAING FINGER ABSC;CMPX
|
Facility
|
OP
|
$3,429.00
|
|
| Hospital Charge Code |
8126011
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$857.25 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$1,323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,743.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Humana ChoiceCare |
$891.54
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,057.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.50
|
| Rate for Payer: Zelis Worker's Compensation |
$936.12
|
|
|
DRAING FINGER ABSC;SMPL
|
Facility
|
OP
|
$1,108.00
|
|
| Hospital Charge Code |
8126010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$1,052.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$941.80
|
| Rate for Payer: First Health Commercial |
$997.20
|
| Rate for Payer: First Health Workers Compensation |
$427.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$997.20
|
| Rate for Payer: GEHA Commercial |
$886.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$997.20
|
| Rate for Payer: Humana ChoiceCare |
$288.08
|
| Rate for Payer: Multiplan All |
$1,008.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$664.80
|
| Rate for Payer: OMNI Networks Commercial |
$775.60
|
| Rate for Payer: One Health Plan PPO/POS |
$997.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,052.60
|
| Rate for Payer: Three Rivers Provider Network All |
$831.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$975.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$277.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,030.44
|
| Rate for Payer: Zelis Auto |
$443.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$554.00
|
| Rate for Payer: Zelis Worker's Compensation |
$302.48
|
|
|
DRAING FINGER ABSC;SMPL
|
Facility
|
IP
|
$1,108.00
|
|
| Hospital Charge Code |
8126010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.48 |
| Max. Negotiated Rate |
$1,052.60 |
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$941.80
|
| Rate for Payer: First Health Commercial |
$997.20
|
| Rate for Payer: First Health Workers Compensation |
$427.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$997.20
|
| Rate for Payer: GEHA Commercial |
$775.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$997.20
|
| Rate for Payer: Multiplan All |
$1,008.28
|
| Rate for Payer: OMNI Networks Commercial |
$775.60
|
| Rate for Payer: One Health Plan PPO/POS |
$997.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,052.60
|
| Rate for Payer: Three Rivers Provider Network All |
$831.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,030.44
|
| Rate for Payer: Zelis Auto |
$443.20
|
| Rate for Payer: Zelis Worker's Compensation |
$302.48
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
IP
|
$1,609.02
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
6126020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$439.26 |
| Max. Negotiated Rate |
$1,528.57 |
| Rate for Payer: Cash Price |
$965.41
|
| Rate for Payer: Cigna Commercial |
$1,367.67
|
| Rate for Payer: First Health Commercial |
$1,448.12
|
| Rate for Payer: First Health Workers Compensation |
$621.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,448.12
|
| Rate for Payer: GEHA Commercial |
$1,126.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,448.12
|
| Rate for Payer: Multiplan All |
$1,464.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,126.31
|
| Rate for Payer: One Health Plan PPO/POS |
$1,448.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,528.57
|
| Rate for Payer: Three Rivers Provider Network All |
$1,206.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,496.39
|
| Rate for Payer: Zelis Auto |
$643.61
|
| Rate for Payer: Zelis Worker's Compensation |
$439.26
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
OP
|
$1,609.02
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
6126020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$439.26 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$965.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$965.41
|
| Rate for Payer: Cash Price |
$965.41
|
| Rate for Payer: Cigna Commercial |
$1,367.67
|
| Rate for Payer: First Health Commercial |
$1,448.12
|
| Rate for Payer: First Health Workers Compensation |
$621.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,448.12
|
| Rate for Payer: GEHA Commercial |
$1,287.22
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,448.12
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,464.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,126.31
|
| Rate for Payer: One Health Plan PPO/POS |
$1,448.12
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,528.57
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,206.77
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,496.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$643.61
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$439.26
|
|
|
DRAIN LOWER LEG BURSA
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 27604
|
| Hospital Charge Code |
6127604
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: First Health Workers Compensation |
$340.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$241.06
|
|
|
DRAIN LOWER LEG BURSA
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 27604
|
| Hospital Charge Code |
6127604
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: First Health Workers Compensation |
$340.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$618.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Worker's Compensation |
$241.06
|
|
|
DRAIN LOWER LEG LESION
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
6127603
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
DRAIN LOWER LEG LESION
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
6127603
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
DRAIN NECK/CHEST LESION
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
6121501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.13 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: First Health Workers Compensation |
$316.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$574.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: Zelis Auto |
$328.40
|
| Rate for Payer: Zelis Worker's Compensation |
$224.13
|
|
|
DRAIN NECK/CHEST LESION
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
6121501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.13 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,962.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,554.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: First Health Workers Compensation |
$316.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$656.80
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,586.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,831.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,586.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,586.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$328.40
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$224.13
|
|
|
DRAIN OPEN ABDOM ABSCESS
|
Facility
|
OP
|
$2,099.00
|
|
|
Service Code
|
CPT 49040
|
| Hospital Charge Code |
6149040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$524.75 |
| Max. Negotiated Rate |
$1,994.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,259.40
|
| Rate for Payer: Cash Price |
$1,259.40
|
| Rate for Payer: Cigna Commercial |
$1,784.15
|
| Rate for Payer: First Health Commercial |
$1,889.10
|
| Rate for Payer: First Health Workers Compensation |
$810.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,889.10
|
| Rate for Payer: GEHA Commercial |
$1,679.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,889.10
|
| Rate for Payer: Humana ChoiceCare |
$545.74
|
| Rate for Payer: Multiplan All |
$1,910.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,259.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,469.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,889.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,994.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,574.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,847.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$524.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,952.07
|
| Rate for Payer: Zelis Auto |
$839.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,049.50
|
| Rate for Payer: Zelis Worker's Compensation |
$573.03
|
|
|
DRAIN OPEN ABDOM ABSCESS
|
Facility
|
IP
|
$2,099.00
|
|
|
Service Code
|
CPT 49040
|
| Hospital Charge Code |
6149040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$573.03 |
| Max. Negotiated Rate |
$1,994.05 |
| Rate for Payer: Cash Price |
$1,259.40
|
| Rate for Payer: Cigna Commercial |
$1,784.15
|
| Rate for Payer: First Health Commercial |
$1,889.10
|
| Rate for Payer: First Health Workers Compensation |
$810.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,889.10
|
| Rate for Payer: GEHA Commercial |
$1,469.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,889.10
|
| Rate for Payer: Multiplan All |
$1,910.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,469.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,889.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,994.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,574.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,952.07
|
| Rate for Payer: Zelis Auto |
$839.60
|
| Rate for Payer: Zelis Worker's Compensation |
$573.03
|
|
