|
LUBRICANT EYE OINTMENT TUBE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 70000051301
|
| Hospital Charge Code |
3301975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$16.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Humana ChoiceCare |
$5.20
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.00
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
|
LUBRIDERM LOTN. 6 OZ BOTTLE
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
NDC 52800048856
|
| Hospital Charge Code |
3300289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$23.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.40
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
LUBRIDERM LOTN. 6 OZ BOTTLE
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
NDC 52800048856
|
| Hospital Charge Code |
3300289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$20.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
LUMBAR PUNCTURE
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
3750000
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$74.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
LUMBAR PUNCTURE
|
Facility
|
IP
|
$2,077.79
|
|
| Hospital Charge Code |
8150097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$567.24 |
| Max. Negotiated Rate |
$1,973.90 |
| Rate for Payer: Cash Price |
$1,246.67
|
| Rate for Payer: Cigna Commercial |
$1,766.12
|
| Rate for Payer: First Health Commercial |
$1,870.01
|
| Rate for Payer: First Health Workers Compensation |
$802.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.01
|
| Rate for Payer: GEHA Commercial |
$1,454.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.01
|
| Rate for Payer: Multiplan All |
$1,890.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.45
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,973.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.34
|
| Rate for Payer: Zelis Auto |
$831.12
|
| Rate for Payer: Zelis Worker's Compensation |
$567.24
|
|
|
LUMBAR PUNCTURE
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
3750000
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$85.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Humana ChoiceCare |
$27.82
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.20
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$94.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
LUMBAR PUNCTURE
|
Facility
|
OP
|
$2,077.79
|
|
| Hospital Charge Code |
8150097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$519.45 |
| Max. Negotiated Rate |
$1,973.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,246.67
|
| Rate for Payer: Cash Price |
$1,246.67
|
| Rate for Payer: Cigna Commercial |
$1,766.12
|
| Rate for Payer: First Health Commercial |
$1,870.01
|
| Rate for Payer: First Health Workers Compensation |
$802.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.01
|
| Rate for Payer: GEHA Commercial |
$1,662.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.01
|
| Rate for Payer: Humana ChoiceCare |
$540.23
|
| Rate for Payer: Multiplan All |
$1,890.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,246.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.45
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,973.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$519.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.34
|
| Rate for Payer: Zelis Auto |
$831.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.89
|
| Rate for Payer: Zelis Worker's Compensation |
$567.24
|
|
|
LUPRON 7.5MG INJ- PT OWN
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
3302626
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
LUPRON 7.5MG INJ- PT OWN
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
3302626
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
lupus anticoagulant compre REF117054
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2299300
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$15.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.93
|
|
|
lupus anticoagulant compre REF117054
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2299300
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.58
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$15.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$187.20
|
| Rate for Payer: GEHA Medicare |
$9.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Humana ChoiceCare |
$10.54
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.58
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.29
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.16
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.58
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Medicare |
$8.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.93
|
|
|
LUPUS ANTICOAGULANT CONFIRMATION
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
2299301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$89.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$119.20
|
| Rate for Payer: GEHA Medicare |
$6.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Humana ChoiceCare |
$6.61
|
| Rate for Payer: Humana Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.01
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.22
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.02
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.89
|
| Rate for Payer: United Healthcare Commercial |
$126.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.01
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Medicare |
$5.11
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.21
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
LUPUS ANTICOAGULANT CONFIRMATION
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
2299301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$104.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
LY CLS SATE HANDS/FEET 12.6\20
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
8150013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,020.00
|
| Rate for Payer: First Health Commercial |
$1,080.00
|
| Rate for Payer: First Health Workers Compensation |
$463.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,080.00
|
| Rate for Payer: GEHA Commercial |
$960.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,080.00
|
| Rate for Payer: Humana ChoiceCare |
$312.00
|
| Rate for Payer: Multiplan All |
$1,092.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$720.00
|
| Rate for Payer: OMNI Networks Commercial |
$840.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,080.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,140.00
|
| Rate for Payer: Three Rivers Provider Network All |
$900.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,056.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,116.00
|
| Rate for Payer: Zelis Auto |
$480.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$600.00
|
| Rate for Payer: Zelis Worker's Compensation |
$327.60
|
|
|
LY CLS SATE HANDS/FEET 12.6\20
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
8150013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,020.00
|
| Rate for Payer: First Health Commercial |
$1,080.00
|
| Rate for Payer: First Health Workers Compensation |
$463.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,080.00
|
| Rate for Payer: GEHA Commercial |
$840.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,080.00
|
| Rate for Payer: Multiplan All |
$1,092.00
|
| Rate for Payer: OMNI Networks Commercial |
$840.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,080.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,140.00
|
| Rate for Payer: Three Rivers Provider Network All |
$900.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,116.00
|
| Rate for Payer: Zelis Auto |
$480.00
|
| Rate for Payer: Zelis Worker's Compensation |
$327.60
|
|
|
lyme dis, ab w/ reflex REF164226
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
2299410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$25.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: GEHA Medicare |
$17.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$18.73
|
| Rate for Payer: Humana Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.03
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.95
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.06
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.69
|
| Rate for Payer: United Healthcare Commercial |
$158.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.03
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Medicare |
$14.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.44
|
| Rate for Payer: Zelis Worker's Compensation |
$18.36
|
|
|
lyme dis, ab w/ reflex REF164226
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
2299410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$25.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.36
|
|
|
lyme dis borrelia burgdorf pcr REF138685
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
2299745
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$35.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$38.60
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$58.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.09
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.65
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.18
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$243.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.09
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$29.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.11
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
lyme dis borrelia burgdorf pcr REF138685
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
2299745
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$55.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$39.21
|
|
|
LYRCLS NHFG 12.6\20CM
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
8150017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$1,019.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Humana ChoiceCare |
$331.24
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$764.40
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,121.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$318.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$637.00
|
| Rate for Payer: Zelis Worker's Compensation |
$347.80
|
|
|
LYRCLS NHFG 12.6\20CM
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
8150017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.80 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$891.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Worker's Compensation |
$347.80
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
6132561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$58.70 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: First Health Workers Compensation |
$83.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$150.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.70
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
6132561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$58.70 |
| Max. Negotiated Rate |
$1,174.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$444.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: First Health Workers Compensation |
$83.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$172.00
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$453.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$523.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$453.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$453.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$58.70
|
|
|
LYSE CHEST FIBRIN SUBQ DAY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
6132562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$136.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
LYSE CHEST FIBRIN SUBQ DAY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
6132562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$1,174.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$444.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$156.00
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$453.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$523.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$453.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$453.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
