|
FLUoxetine HCL 10MG CAP
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
3300349
|
|
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
|
|
|
FLUoxetine HCL 10MG CAP
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 65862019201
|
| Hospital Charge Code |
3300349
|
|
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
|
|
|
fluPHENAZine HCL TAB 1MG
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3300350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
fluPHENAZine HCL TAB 1MG
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 51079048501
|
| Hospital Charge Code |
3300350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
fluPHENAZine HCL TAB 5MG
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 51079048720
|
| Hospital Charge Code |
3300351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
fluPHENAZine HCL TAB 5MG
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 51079048720
|
| Hospital Charge Code |
3300351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
FL UPPER GI SERIES
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
2474240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$149.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$947.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$105.99
|
|
|
FL UPPER GI SERIES
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
2474240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.99 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$149.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.99
|
|
|
FL UPPER GI SERIES W/AIR
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
2400092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$1,132.40 |
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna Commercial |
$1,013.20
|
| Rate for Payer: First Health Commercial |
$1,072.80
|
| Rate for Payer: First Health Workers Compensation |
$170.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.80
|
| Rate for Payer: GEHA Commercial |
$834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.80
|
| Rate for Payer: Multiplan All |
$1,084.72
|
| Rate for Payer: OMNI Networks Commercial |
$834.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,132.40
|
| Rate for Payer: Three Rivers Provider Network All |
$894.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.56
|
| Rate for Payer: Zelis Auto |
$476.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.90
|
|
|
FL UPPER GI SERIES W/AIR
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
2400092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$1,132.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$715.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna Commercial |
$1,013.20
|
| Rate for Payer: First Health Commercial |
$1,072.80
|
| Rate for Payer: First Health Workers Compensation |
$170.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.80
|
| Rate for Payer: GEHA Commercial |
$953.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.80
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$1,084.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$834.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,132.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$894.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$1,013.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$476.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$120.90
|
|
|
FL UPPER GI W/SMALL BOWEL FOLLOW THROUGH
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
2400200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$149.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$947.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$105.99
|
|
|
FL UPPER GI W/SMALL BOWEL FOLLOW THROUGH
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
2400200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.99 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$149.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.99
|
|
|
FLURBIPROFEN SODIUM OPTH 0.03%
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
3300352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.00
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$48.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
FLURBIPROFEN SODIUM OPTH 0.03%
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
3300352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
FL URETHROCYSTOGRAPHY
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
2400065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna Commercial |
$1,002.15
|
| Rate for Payer: First Health Commercial |
$1,061.10
|
| Rate for Payer: First Health Workers Compensation |
$83.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,061.10
|
| Rate for Payer: GEHA Commercial |
$825.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,061.10
|
| Rate for Payer: Multiplan All |
$1,072.89
|
| Rate for Payer: OMNI Networks Commercial |
$825.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,061.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,120.05
|
| Rate for Payer: Three Rivers Provider Network All |
$884.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,096.47
|
| Rate for Payer: Zelis Auto |
$471.60
|
| Rate for Payer: Zelis Worker's Compensation |
$59.32
|
|
|
FL URETHROCYSTOGRAPHY
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
2400065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$257.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$707.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$257.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna Commercial |
$1,002.15
|
| Rate for Payer: First Health Commercial |
$1,061.10
|
| Rate for Payer: First Health Workers Compensation |
$83.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,061.10
|
| Rate for Payer: GEHA Commercial |
$943.20
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,061.10
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,072.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$825.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,061.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$240.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,120.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$884.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,002.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,096.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$471.60
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$59.32
|
|
|
FLURO EXAM OF G/COLON
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
6149465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$226.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$603.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$226.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$179.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$855.10
|
| Rate for Payer: First Health Commercial |
$905.40
|
| Rate for Payer: First Health Workers Compensation |
$295.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$905.40
|
| Rate for Payer: GEHA Commercial |
$804.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$905.40
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$183.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$915.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$704.20
|
| Rate for Payer: One Health Plan PPO/POS |
$905.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$211.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$183.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$955.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$754.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$183.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$935.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$402.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$208.86
|
|
|
FLURO EXAM OF G/COLON
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
6149465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$274.64 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$855.10
|
| Rate for Payer: First Health Commercial |
$905.40
|
| Rate for Payer: First Health Workers Compensation |
$388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$905.40
|
| Rate for Payer: GEHA Commercial |
$704.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$905.40
|
| Rate for Payer: Multiplan All |
$915.46
|
| Rate for Payer: OMNI Networks Commercial |
$704.20
|
| Rate for Payer: One Health Plan PPO/POS |
$905.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$955.70
|
| Rate for Payer: Three Rivers Provider Network All |
$754.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$935.58
|
| Rate for Payer: Zelis Auto |
$402.40
|
| Rate for Payer: Zelis Worker's Compensation |
$274.64
|
|
|
FLUTICASONE FUROATE INH PWD 100 MCG
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
NDC 00173087410
|
| Hospital Charge Code |
3303061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
FLUTICASONE FUROATE INH PWD 100 MCG
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
NDC 00173087410
|
| Hospital Charge Code |
3303061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$289.90
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$669.00
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$981.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$557.50
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
FLUTICASONE NASAL 50MCG/ACT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
NDC 00536118399
|
| Hospital Charge Code |
3300353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$40.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$27.30
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.00
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$92.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.50
|
| Rate for Payer: Zelis Worker's Compensation |
$28.66
|
|
|
FLUTICASONE NASAL 50MCG/ACT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 00536118399
|
| Hospital Charge Code |
3300353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$40.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$73.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.66
|
|
|
FLUTICAS/SALMET 100-50MCG DPI
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
NDC 00378932032
|
| Hospital Charge Code |
3302976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: First Health Workers Compensation |
$233.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$157.04
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$362.40
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$531.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.00
|
| Rate for Payer: Zelis Worker's Compensation |
$164.89
|
|
|
FLUTICAS/SALMET 100-50MCG DPI
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
NDC 00378932032
|
| Hospital Charge Code |
3302976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: First Health Workers Compensation |
$233.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Worker's Compensation |
$164.89
|
|
|
FLUTICAS/SALMET 100-50 MCG- PER PUFF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00378932032
|
| Hospital Charge Code |
3303043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
