|
IR Insert tunneled CVC, 2 caths wo SQ po
|
Facility
|
IP
|
$7,972.00
|
|
|
Service Code
|
CPT 36565
|
| Hospital Charge Code |
7736565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,176.36 |
| Max. Negotiated Rate |
$7,573.40 |
| Rate for Payer: Cash Price |
$4,783.20
|
| Rate for Payer: Cigna Commercial |
$6,776.20
|
| Rate for Payer: First Health Commercial |
$7,174.80
|
| Rate for Payer: First Health Workers Compensation |
$3,077.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,174.80
|
| Rate for Payer: GEHA Commercial |
$5,580.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,174.80
|
| Rate for Payer: Multiplan All |
$7,254.52
|
| Rate for Payer: OMNI Networks Commercial |
$5,580.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,174.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,573.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,979.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,413.96
|
| Rate for Payer: Zelis Auto |
$3,188.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,176.36
|
|
|
IR Insert tunneled CVC, 2 caths wo SQ po
|
Facility
|
OP
|
$7,972.00
|
|
|
Service Code
|
CPT 36565
|
| Hospital Charge Code |
7736565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$7,573.40 |
| Rate for Payer: GEHA Medicare |
$3,049.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,783.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,049.86
|
| Rate for Payer: Cash Price |
$4,783.20
|
| Rate for Payer: Cash Price |
$4,783.20
|
| Rate for Payer: Cigna Commercial |
$6,776.20
|
| Rate for Payer: First Health Commercial |
$7,174.80
|
| Rate for Payer: First Health Workers Compensation |
$3,925.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,174.80
|
| Rate for Payer: GEHA Commercial |
$6,377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,174.80
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: Multiplan All |
$7,254.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| Rate for Payer: OMNI Networks Commercial |
$5,580.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,174.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,573.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: Three Rivers Provider Network All |
$5,979.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,413.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Auto |
$3,188.80
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$2,775.37
|
|
|
IR Insert tunneled CVC, 2 caths w SQ por
|
Facility
|
IP
|
$13,996.00
|
|
|
Service Code
|
CPT 36566
|
| Hospital Charge Code |
7736566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,820.91 |
| Max. Negotiated Rate |
$13,296.20 |
| Rate for Payer: Cash Price |
$8,397.60
|
| Rate for Payer: Cigna Commercial |
$11,896.60
|
| Rate for Payer: First Health Commercial |
$12,596.40
|
| Rate for Payer: First Health Workers Compensation |
$5,403.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,596.40
|
| Rate for Payer: GEHA Commercial |
$9,797.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,596.40
|
| Rate for Payer: Multiplan All |
$12,736.36
|
| Rate for Payer: OMNI Networks Commercial |
$9,797.20
|
| Rate for Payer: One Health Plan PPO/POS |
$12,596.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,296.20
|
| Rate for Payer: Three Rivers Provider Network All |
$10,497.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,016.28
|
| Rate for Payer: Zelis Auto |
$5,598.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3,820.91
|
|
|
IR Insert tunneled CVC, 2 caths w SQ por
|
Facility
|
OP
|
$13,996.00
|
|
|
Service Code
|
CPT 36566
|
| Hospital Charge Code |
7736566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$13,296.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,397.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,238.02
|
| Rate for Payer: Cash Price |
$8,397.60
|
| Rate for Payer: Cash Price |
$8,397.60
|
| Rate for Payer: Cigna Commercial |
$11,896.60
|
| Rate for Payer: First Health Commercial |
$12,596.40
|
| Rate for Payer: First Health Workers Compensation |
$6,741.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,596.40
|
| Rate for Payer: GEHA Commercial |
$11,196.80
|
| Rate for Payer: GEHA Medicare |
$5,238.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,596.40
|
| Rate for Payer: Humana ChoiceCare |
$5,761.82
|
| Rate for Payer: Humana Medicare Advantage |
$5,238.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,799.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,238.02
|
| Rate for Payer: Multiplan All |
$12,736.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,904.63
|
| Rate for Payer: OMNI Networks Commercial |
$9,797.20
|
| Rate for Payer: One Health Plan PPO/POS |
$12,596.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,238.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,296.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,476.04
|
| Rate for Payer: Three Rivers Provider Network All |
$10,497.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,133.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,238.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,016.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,238.02
|
| Rate for Payer: Zelis Auto |
$5,598.40
|
| Rate for Payer: Zelis Medicare |
$4,452.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,285.62
|
| Rate for Payer: Zelis Worker's Compensation |
$4,766.60
|
|
|
IR INTRAVERTEBRAL DISC BIOPSY
|
Facility
|
IP
|
$2,493.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
2462267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$680.59 |
| Max. Negotiated Rate |
$2,368.35 |
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cigna Commercial |
$2,119.05
|
| Rate for Payer: First Health Commercial |
$2,243.70
|
| Rate for Payer: First Health Workers Compensation |
$962.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,243.70
|
| Rate for Payer: GEHA Commercial |
$1,745.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,243.70
|
| Rate for Payer: Multiplan All |
$2,268.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,745.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,243.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,368.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,869.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,318.49
|
| Rate for Payer: Zelis Auto |
$997.20
|
| Rate for Payer: Zelis Worker's Compensation |
$680.59
|
|
|
IR INTRAVERTEBRAL DISC BIOPSY
|
Facility
|
OP
|
$2,493.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
2462267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$368.38 |
| Max. Negotiated Rate |
$2,368.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,495.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$681.76
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cigna Commercial |
$2,119.05
|
| Rate for Payer: First Health Commercial |
$2,243.70
|
| Rate for Payer: First Health Workers Compensation |
$877.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,243.70
|
| Rate for Payer: GEHA Commercial |
$1,994.40
|
| Rate for Payer: GEHA Medicare |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,243.70
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$2,268.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,745.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,243.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,368.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,869.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,318.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$997.20
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| Rate for Payer: Zelis Worker's Compensation |
$620.40
|
|
|
IR LE ANGIOGRAM PROCEDURE
|
Facility
|
OP
|
$4,491.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
2436140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,122.75 |
| Max. Negotiated Rate |
$4,266.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,694.60
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cigna Commercial |
$3,817.35
|
| Rate for Payer: First Health Commercial |
$4,041.90
|
| Rate for Payer: First Health Workers Compensation |
$1,733.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,041.90
|
| Rate for Payer: GEHA Commercial |
$3,592.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,041.90
|
| Rate for Payer: Humana ChoiceCare |
$1,167.66
|
| Rate for Payer: Multiplan All |
$4,086.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,143.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,041.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,266.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,368.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,952.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,122.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,176.63
|
| Rate for Payer: Zelis Auto |
$1,796.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,245.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,226.04
|
|
|
IR LE ANGIOGRAM PROCEDURE
|
Facility
|
IP
|
$4,491.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
2436140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,226.04 |
| Max. Negotiated Rate |
$4,266.45 |
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cigna Commercial |
$3,817.35
|
| Rate for Payer: First Health Commercial |
$4,041.90
|
| Rate for Payer: First Health Workers Compensation |
$1,733.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,041.90
|
| Rate for Payer: GEHA Commercial |
$3,143.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,041.90
|
| Rate for Payer: Multiplan All |
$4,086.81
|
| Rate for Payer: OMNI Networks Commercial |
$3,143.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,041.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,266.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,368.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,176.63
|
| Rate for Payer: Zelis Auto |
$1,796.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,226.04
|
|
|
IR LE ANGIOGRAM RAD
|
Facility
|
OP
|
$7,291.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
2475710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.23 |
| Max. Negotiated Rate |
$6,926.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,943.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,374.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,943.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,331.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,049.86
|
| Rate for Payer: Cash Price |
$4,374.60
|
| Rate for Payer: Cash Price |
$4,374.60
|
| Rate for Payer: Cigna Commercial |
$6,197.35
|
| Rate for Payer: First Health Commercial |
$6,561.90
|
| Rate for Payer: First Health Workers Compensation |
$252.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,561.90
|
| Rate for Payer: GEHA Commercial |
$5,832.80
|
| Rate for Payer: GEHA Medicare |
$3,049.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,561.90
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,379.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: Multiplan All |
$6,634.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| Rate for Payer: OMNI Networks Commercial |
$5,103.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,561.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,747.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,379.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,926.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: Three Rivers Provider Network All |
$5,468.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,379.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,780.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Auto |
$2,916.40
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$178.23
|
|
|
IR LE ANGIOGRAM RAD
|
Facility
|
IP
|
$7,291.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
2475710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.23 |
| Max. Negotiated Rate |
$6,926.45 |
| Rate for Payer: Cash Price |
$4,374.60
|
| Rate for Payer: Cash Price |
$4,374.60
|
| Rate for Payer: Cigna Commercial |
$6,197.35
|
| Rate for Payer: First Health Commercial |
$6,561.90
|
| Rate for Payer: First Health Workers Compensation |
$252.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,561.90
|
| Rate for Payer: GEHA Commercial |
$5,103.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,561.90
|
| Rate for Payer: Multiplan All |
$6,634.81
|
| Rate for Payer: OMNI Networks Commercial |
$5,103.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,561.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,926.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,468.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,780.63
|
| Rate for Payer: Zelis Auto |
$2,916.40
|
| Rate for Payer: Zelis Worker's Compensation |
$178.23
|
|
|
IR LEVEL FIVE
|
Facility
|
OP
|
$6,598.00
|
|
| Hospital Charge Code |
2496005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,649.50 |
| Max. Negotiated Rate |
$6,268.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,958.80
|
| Rate for Payer: Cash Price |
$3,958.80
|
| Rate for Payer: Cigna Commercial |
$5,608.30
|
| Rate for Payer: First Health Commercial |
$5,938.20
|
| Rate for Payer: First Health Workers Compensation |
$2,547.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,938.20
|
| Rate for Payer: GEHA Commercial |
$5,278.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,938.20
|
| Rate for Payer: Humana ChoiceCare |
$1,715.48
|
| Rate for Payer: Multiplan All |
$6,004.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,958.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,618.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,938.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,268.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,948.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,649.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,136.14
|
| Rate for Payer: Zelis Auto |
$2,639.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,299.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,801.25
|
|
|
IR LEVEL FIVE
|
Facility
|
IP
|
$6,598.00
|
|
| Hospital Charge Code |
2496005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,801.25 |
| Max. Negotiated Rate |
$6,268.10 |
| Rate for Payer: Cash Price |
$3,958.80
|
| Rate for Payer: Cigna Commercial |
$5,608.30
|
| Rate for Payer: First Health Commercial |
$5,938.20
|
| Rate for Payer: First Health Workers Compensation |
$2,547.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,938.20
|
| Rate for Payer: GEHA Commercial |
$4,618.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,938.20
|
| Rate for Payer: Multiplan All |
$6,004.18
|
| Rate for Payer: OMNI Networks Commercial |
$4,618.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,938.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,268.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,948.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,136.14
|
| Rate for Payer: Zelis Auto |
$2,639.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,801.25
|
|
|
IR LEVEL FOUR
|
Facility
|
OP
|
$4,568.00
|
|
| Hospital Charge Code |
2496004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$4,339.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,740.80
|
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cigna Commercial |
$3,882.80
|
| Rate for Payer: First Health Commercial |
$4,111.20
|
| Rate for Payer: First Health Workers Compensation |
$1,763.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,111.20
|
| Rate for Payer: GEHA Commercial |
$3,654.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,111.20
|
| Rate for Payer: Humana ChoiceCare |
$1,187.68
|
| Rate for Payer: Multiplan All |
$4,156.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,740.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,197.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,111.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,339.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,426.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,019.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,142.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,248.24
|
| Rate for Payer: Zelis Auto |
$1,827.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,284.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,247.06
|
|
|
IR LEVEL FOUR
|
Facility
|
IP
|
$4,568.00
|
|
| Hospital Charge Code |
2496004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,247.06 |
| Max. Negotiated Rate |
$4,339.60 |
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cigna Commercial |
$3,882.80
|
| Rate for Payer: First Health Commercial |
$4,111.20
|
| Rate for Payer: First Health Workers Compensation |
$1,763.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,111.20
|
| Rate for Payer: GEHA Commercial |
$3,197.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,111.20
|
| Rate for Payer: Multiplan All |
$4,156.88
|
| Rate for Payer: OMNI Networks Commercial |
$3,197.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,111.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,339.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,248.24
|
| Rate for Payer: Zelis Auto |
$1,827.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,247.06
|
|
|
IR LEVEL ONE
|
Facility
|
OP
|
$1,523.00
|
|
| Hospital Charge Code |
2496001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
IR LEVEL ONE
|
Facility
|
IP
|
$1,523.00
|
|
| Hospital Charge Code |
2496001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
IR LEVEL THREE
|
Facility
|
OP
|
$3,553.00
|
|
| Hospital Charge Code |
2496003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$888.25 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,131.80
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,020.05
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: First Health Workers Compensation |
$1,371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,197.70
|
| Rate for Payer: GEHA Commercial |
$2,842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,197.70
|
| Rate for Payer: Humana ChoiceCare |
$923.78
|
| Rate for Payer: Multiplan All |
$3,233.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,131.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,487.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,197.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,375.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,664.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,126.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$888.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,304.29
|
| Rate for Payer: Zelis Auto |
$1,421.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,776.50
|
| Rate for Payer: Zelis Worker's Compensation |
$969.97
|
|
|
IR LEVEL THREE
|
Facility
|
IP
|
$3,553.00
|
|
| Hospital Charge Code |
2496003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$969.97 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,020.05
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: First Health Workers Compensation |
$1,371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,197.70
|
| Rate for Payer: GEHA Commercial |
$2,487.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,197.70
|
| Rate for Payer: Multiplan All |
$3,233.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,487.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,197.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,375.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,664.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,304.29
|
| Rate for Payer: Zelis Auto |
$1,421.20
|
| Rate for Payer: Zelis Worker's Compensation |
$969.97
|
|
|
IR LEVEL TWO
|
Facility
|
OP
|
$2,538.00
|
|
| Hospital Charge Code |
2496002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$634.50 |
| Max. Negotiated Rate |
$2,411.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,522.80
|
| Rate for Payer: Cash Price |
$1,522.80
|
| Rate for Payer: Cigna Commercial |
$2,157.30
|
| Rate for Payer: First Health Commercial |
$2,284.20
|
| Rate for Payer: First Health Workers Compensation |
$979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,284.20
|
| Rate for Payer: GEHA Commercial |
$2,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,284.20
|
| Rate for Payer: Humana ChoiceCare |
$659.88
|
| Rate for Payer: Multiplan All |
$2,309.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,522.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,776.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,284.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,411.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,903.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,233.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$634.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,360.34
|
| Rate for Payer: Zelis Auto |
$1,015.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,269.00
|
| Rate for Payer: Zelis Worker's Compensation |
$692.87
|
|
|
IR LEVEL TWO
|
Facility
|
IP
|
$2,538.00
|
|
| Hospital Charge Code |
2496002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$692.87 |
| Max. Negotiated Rate |
$2,411.10 |
| Rate for Payer: Cash Price |
$1,522.80
|
| Rate for Payer: Cigna Commercial |
$2,157.30
|
| Rate for Payer: First Health Commercial |
$2,284.20
|
| Rate for Payer: First Health Workers Compensation |
$979.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,284.20
|
| Rate for Payer: GEHA Commercial |
$1,776.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,284.20
|
| Rate for Payer: Multiplan All |
$2,309.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,776.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,284.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,411.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,903.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,360.34
|
| Rate for Payer: Zelis Auto |
$1,015.20
|
| Rate for Payer: Zelis Worker's Compensation |
$692.87
|
|
|
IR LOCAL FACILITY ANESTHESIA
|
Facility
|
OP
|
$914.00
|
|
| Hospital Charge Code |
2400242
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: First Health Workers Compensation |
$352.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$731.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Humana ChoiceCare |
$237.64
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$548.40
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$804.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.00
|
| Rate for Payer: Zelis Worker's Compensation |
$249.52
|
|
|
IR LOCAL FACILITY ANESTHESIA
|
Facility
|
IP
|
$914.00
|
|
| Hospital Charge Code |
2400242
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$249.52 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: First Health Workers Compensation |
$352.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$639.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Worker's Compensation |
$249.52
|
|
|
IR LUMBAR SPINAL TAP
|
Facility
|
OP
|
$2,109.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
2407230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$2,003.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$937.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,265.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$937.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$742.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$671.04
|
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cigna Commercial |
$1,792.65
|
| Rate for Payer: First Health Commercial |
$1,898.10
|
| Rate for Payer: First Health Workers Compensation |
$863.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,898.10
|
| Rate for Payer: GEHA Commercial |
$1,687.20
|
| Rate for Payer: GEHA Medicare |
$671.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,898.10
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Humana Medicare Advantage |
$671.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$757.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$671.04
|
| Rate for Payer: Multiplan All |
$1,919.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,476.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,898.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$875.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$757.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$671.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,003.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,342.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,581.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$757.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$671.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,961.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$671.04
|
| Rate for Payer: Zelis Auto |
$843.60
|
| Rate for Payer: Zelis Medicare |
$570.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$805.25
|
| Rate for Payer: Zelis Worker's Compensation |
$610.65
|
|
|
IR LUMBAR SPINAL TAP
|
Facility
|
IP
|
$2,109.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
2407230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$575.76 |
| Max. Negotiated Rate |
$2,003.55 |
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cigna Commercial |
$1,792.65
|
| Rate for Payer: First Health Commercial |
$1,898.10
|
| Rate for Payer: First Health Workers Compensation |
$814.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,898.10
|
| Rate for Payer: GEHA Commercial |
$1,476.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,898.10
|
| Rate for Payer: Multiplan All |
$1,919.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,476.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,898.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,003.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,581.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,961.37
|
| Rate for Payer: Zelis Auto |
$843.60
|
| Rate for Payer: Zelis Worker's Compensation |
$575.76
|
|
|
IR LYMPH NODE BX
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
2438505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.87 |
| Max. Negotiated Rate |
$2,710.35 |
| Rate for Payer: Cash Price |
$1,711.80
|
| Rate for Payer: Cigna Commercial |
$2,425.05
|
| Rate for Payer: First Health Commercial |
$2,567.70
|
| Rate for Payer: First Health Workers Compensation |
$1,101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,567.70
|
| Rate for Payer: GEHA Commercial |
$1,997.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,567.70
|
| Rate for Payer: Multiplan All |
$2,596.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,997.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,567.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,710.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,139.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,653.29
|
| Rate for Payer: Zelis Auto |
$1,141.20
|
| Rate for Payer: Zelis Worker's Compensation |
$778.87
|
|
