|
30903 ANT NASAL CAUT EXT
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
8300044
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$251.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$456.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Worker's Compensation |
$178.00
|
|
|
30 DAY REPORT INTERPRETATION
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
4093272
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$364.65
|
| Rate for Payer: First Health Commercial |
$386.10
|
| Rate for Payer: First Health Workers Compensation |
$165.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.10
|
| Rate for Payer: GEHA Commercial |
$300.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.10
|
| Rate for Payer: Multiplan All |
$390.39
|
| Rate for Payer: OMNI Networks Commercial |
$300.30
|
| Rate for Payer: One Health Plan PPO/POS |
$386.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$407.55
|
| Rate for Payer: Three Rivers Provider Network All |
$321.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.97
|
| Rate for Payer: Zelis Auto |
$171.60
|
| Rate for Payer: Zelis Worker's Compensation |
$117.12
|
|
|
30 DAY REPORT INTERPRETATION
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
4093272
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$364.65
|
| Rate for Payer: First Health Commercial |
$386.10
|
| Rate for Payer: First Health Workers Compensation |
$165.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.10
|
| Rate for Payer: GEHA Commercial |
$343.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.10
|
| Rate for Payer: Humana ChoiceCare |
$111.54
|
| Rate for Payer: Multiplan All |
$390.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.40
|
| Rate for Payer: OMNI Networks Commercial |
$300.30
|
| Rate for Payer: One Health Plan PPO/POS |
$386.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$407.55
|
| Rate for Payer: Three Rivers Provider Network All |
$321.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$377.52
|
| Rate for Payer: United Healthcare Commercial |
$364.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.97
|
| Rate for Payer: Zelis Auto |
$171.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$214.50
|
| Rate for Payer: Zelis Worker's Compensation |
$117.12
|
|
|
30 mCi IODINE I-131
|
Facility
|
OP
|
$4,324.00
|
|
|
Service Code
|
CPT A9517
|
| Hospital Charge Code |
2509518
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$4,107.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,594.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.13
|
| Rate for Payer: Cash Price |
$2,594.40
|
| Rate for Payer: Cash Price |
$2,594.40
|
| Rate for Payer: Cigna Commercial |
$3,675.40
|
| Rate for Payer: First Health Commercial |
$3,891.60
|
| Rate for Payer: First Health Workers Compensation |
$1,669.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,891.60
|
| Rate for Payer: GEHA Commercial |
$3,459.20
|
| Rate for Payer: GEHA Medicare |
$23.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,891.60
|
| Rate for Payer: Humana ChoiceCare |
$25.44
|
| Rate for Payer: Humana Medicare Advantage |
$23.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$38.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.13
|
| Rate for Payer: Multiplan All |
$3,934.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.32
|
| Rate for Payer: OMNI Networks Commercial |
$3,026.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,891.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,107.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.26
|
| Rate for Payer: Three Rivers Provider Network All |
$3,243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.67
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,021.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.13
|
| Rate for Payer: Zelis Auto |
$1,729.60
|
| Rate for Payer: Zelis Medicare |
$19.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.76
|
| Rate for Payer: Zelis Worker's Compensation |
$1,180.45
|
|
|
30 mCi IODINE I-131
|
Facility
|
IP
|
$4,324.00
|
|
|
Service Code
|
CPT A9517
|
| Hospital Charge Code |
2509518
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,180.45 |
| Max. Negotiated Rate |
$4,107.80 |
| Rate for Payer: Cash Price |
$2,594.40
|
| Rate for Payer: Cigna Commercial |
$3,675.40
|
| Rate for Payer: First Health Commercial |
$3,891.60
|
| Rate for Payer: First Health Workers Compensation |
$1,669.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,891.60
|
| Rate for Payer: GEHA Commercial |
$3,026.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,891.60
|
| Rate for Payer: Multiplan All |
$3,934.84
|
| Rate for Payer: OMNI Networks Commercial |
$3,026.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,891.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,107.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,021.32
|
| Rate for Payer: Zelis Auto |
$1,729.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,180.45
|
|
|
31295 MAXILLARY ENDO W/DILATION
|
Facility
|
OP
|
$5,660.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
7931295
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,545.18 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cigna Commercial |
$4,811.00
|
| Rate for Payer: First Health Commercial |
$5,094.00
|
| Rate for Payer: First Health Workers Compensation |
$2,185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.00
|
| Rate for Payer: GEHA Commercial |
$4,528.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.00
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$5,150.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,263.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$2,264.00
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$1,545.18
|
|
|
31295 MAXILLARY ENDO W/DILATION
|
Facility
|
IP
|
$5,660.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
7931295
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,545.18 |
| Max. Negotiated Rate |
$5,377.00 |
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cigna Commercial |
$4,811.00
|
| Rate for Payer: First Health Commercial |
$5,094.00
|
| Rate for Payer: First Health Workers Compensation |
$2,185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.00
|
| Rate for Payer: GEHA Commercial |
$3,962.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.00
|
| Rate for Payer: Multiplan All |
$5,150.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,263.80
|
| Rate for Payer: Zelis Auto |
$2,264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,545.18
|
|
|
31297 SPHENOID ENDO W/BAL DILATION
|
Facility
|
OP
|
$5,616.00
|
|
|
Service Code
|
CPT 31297
|
| Hospital Charge Code |
7931297
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,533.17 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,369.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$4,773.60
|
| Rate for Payer: First Health Commercial |
$5,054.40
|
| Rate for Payer: First Health Workers Compensation |
$2,168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,054.40
|
| Rate for Payer: GEHA Commercial |
$4,492.80
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,054.40
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$5,110.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,931.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,054.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,335.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,212.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,222.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$2,246.40
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$1,533.17
|
|
|
31297 SPHENOID ENDO W/BAL DILATION
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
CPT 31297
|
| Hospital Charge Code |
7931297
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,533.17 |
| Max. Negotiated Rate |
$5,335.20 |
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$4,773.60
|
| Rate for Payer: First Health Commercial |
$5,054.40
|
| Rate for Payer: First Health Workers Compensation |
$2,168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,054.40
|
| Rate for Payer: GEHA Commercial |
$3,931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,054.40
|
| Rate for Payer: Multiplan All |
$5,110.56
|
| Rate for Payer: OMNI Networks Commercial |
$3,931.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,054.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,335.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,212.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,222.88
|
| Rate for Payer: Zelis Auto |
$2,246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,533.17
|
|
|
31575 LARYNGOSCOPY FIBEROPTIC
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
7931575
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$368.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$184.34
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: GEHA Medicare |
$184.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Humana ChoiceCare |
$202.77
|
| Rate for Payer: Humana Medicare Advantage |
$184.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$309.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$184.34
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$313.38
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$184.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$368.68
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$180.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$184.34
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Medicare |
$156.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.21
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
31575 LARYNGOSCOPY FIBEROPTIC
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
7931575
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
40 - 64 YRS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
7299386
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
40 - 64 YRS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
7299386
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
40-64 YRS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
8599386
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
40-64 YRS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
8599386
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
42960 CONTROL THROAT BLEEDING
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
7942960
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
42960 CONTROL THROAT BLEEDING
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
7942960
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
42970 CONTROL NOSE/THROAT BLEED
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
7942970
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$746.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$995.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
42970 CONTROL NOSE/THROAT BLEED
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
7942970
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$870.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
4.5MM CORTICAL SCREWS 27.5MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
4.5MM CORTICAL SCREWS 27.5MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
4.5MM CORTICAL SCREWS 30MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
4.5MM CORTICAL SCREWS 30MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
4.5MM CORTICAL SCREWS 32.5MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
4.5MM CORTICAL SCREWS 32.5MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
