|
GLUCOSE POCT
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
2200015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$32.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
GLUCOSE POCT
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
2200015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$37.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.36
|
| Rate for Payer: United Healthcare Commercial |
$39.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
GLUCOSE TAB 4GM
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 00904671015
|
| Hospital Charge Code |
3301113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
GLUCOSE TAB 4GM
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00904671015
|
| Hospital Charge Code |
3301113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
GLUCOSE (Vitros)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2232193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: GEHA Medicare |
$3.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$4.32
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.93
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.68
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.86
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.93
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Medicare |
$3.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.72
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
GLUCOSE (Vitros)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
2232193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$7.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.49
|
|
|
gluten sensitivity abs REF164125
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
gluten sensitivity abs REF164125
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
GlyBURIDE TAB 5MG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00093936401
|
| Hospital Charge Code |
3300387
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
GlyBURIDE TAB 5MG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00093936401
|
| Hospital Charge Code |
3300387
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
GLYCERIN
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
NDC 00395103196
|
| Hospital Charge Code |
3300388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$37.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
GLYCERIN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
NDC 00395103196
|
| Hospital Charge Code |
3300388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$42.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Humana ChoiceCare |
$13.78
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.80
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.50
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
GLYCERIN SUPPOS 2.1GM
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
3300389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
GLYCERIN SUPPOS 2.1GM
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 58980041012
|
| Hospital Charge Code |
3300389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
glycomark REF500115
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
2299660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$20.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.17
|
|
|
glycomark REF500115
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
2299660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$20.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.17
|
|
|
GLYCOPYRROLATE INJ 0.2MG/ML
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
GLYCOPYRROLATE INJ 0.2MG/ML
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
gm1 IgG autoantibody REF140385
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
gm1 IgG autoantibody REF140385
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
gm1 IgM autoantibodies REF140280
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
gm1 IgM autoantibodies REF140280
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
gonadotropin releasing hormone REF502421
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 83727
|
| Hospital Charge Code |
2299755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.19
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$17.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$18.91
|
| Rate for Payer: Humana Medicare Advantage |
$17.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.19
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.22
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.38
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.19
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$14.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.63
|
| Rate for Payer: Zelis Worker's Compensation |
$22.43
|
|
|
gonadotropin releasing hormone REF502421
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 83727
|
| Hospital Charge Code |
2299755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$31.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.43
|
|
|
GRAFIX 1.6CM DISC GRAFIXPL
|
Facility
|
IP
|
$1,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$783.60 |
| Max. Negotiated Rate |
$1,861.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,567.20
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$1,665.15
|
| Rate for Payer: First Health Commercial |
$1,763.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,763.10
|
| Rate for Payer: GEHA Commercial |
$1,371.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,763.10
|
| Rate for Payer: Multiplan All |
$1,782.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,371.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,763.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,861.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,469.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,821.87
|
| Rate for Payer: Zelis Auto |
$783.60
|
|
