|
LIPID PANEL AMA (Vitros)
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
2232186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$23.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.58
|
|
|
LIPID PANEL AMA (Vitros)
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
2232186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$23.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: GEHA Medicare |
$13.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$14.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.39
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.76
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.78
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$214.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.39
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Medicare |
$11.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.07
|
| Rate for Payer: Zelis Worker's Compensation |
$16.58
|
|
|
lipid panel (labcorp) REF303756
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
2200807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$23.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.58
|
|
|
lipid panel (labcorp) REF303756
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
2200807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$23.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: GEHA Medicare |
$13.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$14.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.39
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.76
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.78
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$214.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.39
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Medicare |
$11.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.07
|
| Rate for Payer: Zelis Worker's Compensation |
$16.58
|
|
|
LIPIDS 20% 50 GM/250 ML IVPB
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
NDC 63323082004
|
| Hospital Charge Code |
3300321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
LIPIDS 20% 50 GM/250 ML IVPB
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
NDC 63323082004
|
| Hospital Charge Code |
3300321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$42.64
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$98.40
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$144.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
LIPIPLASTY 3.0 INTERFRAG SCREW
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
LIPIPLASTY 3.0 INTERFRAG SCREW
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
LIPIPLASTY 3.5 TRANSVERSE SCREW
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
LIPIPLASTY 3.5 TRANSVERSE SCREW
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
LIPIPLASTY SYSTEM 2
|
Facility
|
OP
|
$14,430.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,607.50 |
| Max. Negotiated Rate |
$13,708.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,658.00
|
| Rate for Payer: Cash Price |
$8,658.00
|
| Rate for Payer: Cash Price |
$8,658.00
|
| Rate for Payer: Cigna Commercial |
$12,265.50
|
| Rate for Payer: First Health Commercial |
$12,987.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,987.00
|
| Rate for Payer: GEHA Commercial |
$11,544.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,987.00
|
| Rate for Payer: Humana ChoiceCare |
$3,751.80
|
| Rate for Payer: Multiplan All |
$13,131.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,658.00
|
| Rate for Payer: OMNI Networks Commercial |
$10,101.00
|
| Rate for Payer: One Health Plan PPO/POS |
$12,987.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,708.50
|
| Rate for Payer: Three Rivers Provider Network All |
$10,822.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,698.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,607.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,419.90
|
| Rate for Payer: Zelis Auto |
$5,772.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,215.00
|
|
|
LIPIPLASTY SYSTEM 2
|
Facility
|
IP
|
$14,430.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,772.00 |
| Max. Negotiated Rate |
$13,708.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,544.00
|
| Rate for Payer: Cash Price |
$8,658.00
|
| Rate for Payer: Cash Price |
$8,658.00
|
| Rate for Payer: Cigna Commercial |
$12,265.50
|
| Rate for Payer: First Health Commercial |
$12,987.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,987.00
|
| Rate for Payer: GEHA Commercial |
$10,101.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,987.00
|
| Rate for Payer: Multiplan All |
$13,131.30
|
| Rate for Payer: OMNI Networks Commercial |
$10,101.00
|
| Rate for Payer: One Health Plan PPO/POS |
$12,987.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,708.50
|
| Rate for Payer: Three Rivers Provider Network All |
$10,822.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,419.90
|
| Rate for Payer: Zelis Auto |
$5,772.00
|
|
|
LIPIPLASTY SYSTEM 3
|
Facility
|
OP
|
$20,367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,091.75 |
| Max. Negotiated Rate |
$19,348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,220.20
|
| Rate for Payer: Cash Price |
$12,220.20
|
| Rate for Payer: Cash Price |
$12,220.20
|
| Rate for Payer: Cigna Commercial |
$17,311.95
|
| Rate for Payer: First Health Commercial |
$18,330.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,330.30
|
| Rate for Payer: GEHA Commercial |
$16,293.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,330.30
|
| Rate for Payer: Humana ChoiceCare |
$5,295.42
|
| Rate for Payer: Multiplan All |
$18,533.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,220.20
|
| Rate for Payer: OMNI Networks Commercial |
$14,256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$18,330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$15,275.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,922.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,091.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,941.31
|
| Rate for Payer: Zelis Auto |
$8,146.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,183.50
|
|
|
LIPIPLASTY SYSTEM 3
|
Facility
|
IP
|
$20,367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,146.80 |
| Max. Negotiated Rate |
$19,348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,293.60
|
| Rate for Payer: Cash Price |
$12,220.20
|
| Rate for Payer: Cash Price |
$12,220.20
|
| Rate for Payer: Cigna Commercial |
$17,311.95
|
| Rate for Payer: First Health Commercial |
$18,330.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,330.30
|
| Rate for Payer: GEHA Commercial |
$14,256.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,330.30
|
| Rate for Payer: Multiplan All |
$18,533.97
|
| Rate for Payer: OMNI Networks Commercial |
$14,256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$18,330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$15,275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,941.31
|
| Rate for Payer: Zelis Auto |
$8,146.80
|
|
|
LIPIPLASTY SYSTEM 4
|
Facility
|
IP
|
$14,700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,880.00 |
| Max. Negotiated Rate |
$13,965.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,760.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: Cigna Commercial |
$12,495.00
|
| Rate for Payer: First Health Commercial |
$13,230.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,230.00
|
| Rate for Payer: GEHA Commercial |
$10,290.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,230.00
|
| Rate for Payer: Multiplan All |
$13,377.00
|
| Rate for Payer: OMNI Networks Commercial |
$10,290.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,230.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,965.00
|
| Rate for Payer: Three Rivers Provider Network All |
$11,025.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,671.00
|
| Rate for Payer: Zelis Auto |
$5,880.00
|
|
|
LIPIPLASTY SYSTEM 4
|
Facility
|
OP
|
$14,700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,675.00 |
| Max. Negotiated Rate |
$13,965.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,820.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: Cigna Commercial |
$12,495.00
|
| Rate for Payer: First Health Commercial |
$13,230.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,230.00
|
| Rate for Payer: GEHA Commercial |
$11,760.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,230.00
|
| Rate for Payer: Humana ChoiceCare |
$3,822.00
|
| Rate for Payer: Multiplan All |
$13,377.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,820.00
|
| Rate for Payer: OMNI Networks Commercial |
$10,290.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,230.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,965.00
|
| Rate for Payer: Three Rivers Provider Network All |
$11,025.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,936.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,675.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,671.00
|
| Rate for Payer: Zelis Auto |
$5,880.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,350.00
|
|
|
lipoprotein a REF120188
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
2299685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.73 |
| 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 |
$23.66
|
| 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 |
$16.73
|
|
|
lipoprotein a REF120188
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
2299685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.77
|
| 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 |
$25.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.32
|
| 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 |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$14.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$15.75
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.32
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.34
|
| 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 |
$24.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.64
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.03
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.32
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$12.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.18
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
LIPOPROTEIN ASSOCIATED PHOSPHAOLIPASE A2
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 83698
|
| Hospital Charge Code |
2299655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$46.31
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$52.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: GEHA Medicare |
$46.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$50.94
|
| Rate for Payer: Humana Medicare Advantage |
$46.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$77.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$46.31
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$78.73
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$77.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$46.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$92.62
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45.38
|
| Rate for Payer: United Healthcare Commercial |
$220.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$46.31
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Medicare |
$39.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.57
|
| Rate for Payer: Zelis Worker's Compensation |
$37.09
|
|
|
LIPOPROTEIN ASSOCIATED PHOSPHAOLIPASE A2
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 83698
|
| Hospital Charge Code |
2299655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$52.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$37.09
|
|
|
lipoprotein pla2 REF123283
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 83698
|
| Hospital Charge Code |
2200738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$46.31
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$52.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: GEHA Medicare |
$46.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$50.94
|
| Rate for Payer: Humana Medicare Advantage |
$46.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$77.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$46.31
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$78.73
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$77.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$46.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$92.62
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45.38
|
| Rate for Payer: United Healthcare Commercial |
$220.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$46.31
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Medicare |
$39.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.57
|
| Rate for Payer: Zelis Worker's Compensation |
$37.09
|
|
|
lipoprotein pla2 REF123283
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 83698
|
| Hospital Charge Code |
2200738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$52.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$37.09
|
|
|
LISINOPRIL 10MG TAB
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
3300532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
LISINOPRIL 10MG TAB
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 00904679861
|
| Hospital Charge Code |
3300532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
LISINOPRIL 20MG TAB
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 00904679961
|
| Hospital Charge Code |
3300533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
