|
MAGNESIUM SULF 40 GM/1000 ML IV
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
3301137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$0.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$13.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.00
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
MAGNESIUM SULF 40 GM/1000 ML IV
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
3301137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
MAGNESIUM SULFATE 1GM PREMIX
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
3300552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: First Health Workers Compensation |
$9.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$0.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Humana ChoiceCare |
$6.24
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.40
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: Zelis Auto |
$9.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.55
|
|
|
MAGNESIUM SULFATE 1GM PREMIX
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
3300552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: First Health Workers Compensation |
$9.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: Zelis Auto |
$9.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.55
|
|
|
MAGNESIUM SULFATE 2GM PREMIX
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
3300553
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$9.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
MAGNESIUM SULFATE 2GM PREMIX
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT J3475
|
| Hospital Charge Code |
3300553
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: First Health Commercial |
$12.60
|
| Rate for Payer: First Health Workers Compensation |
$5.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12.60
|
| Rate for Payer: GEHA Commercial |
$0.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$3.64
|
| Rate for Payer: Multiplan All |
$12.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.40
|
| Rate for Payer: OMNI Networks Commercial |
$9.80
|
| Rate for Payer: One Health Plan PPO/POS |
$12.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13.30
|
| Rate for Payer: Three Rivers Provider Network All |
$10.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.02
|
| Rate for Payer: Zelis Auto |
$5.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.82
|
|
|
MAGNESIUM UA POP
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2299380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$12.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.37
|
| Rate for Payer: Humana Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.70
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.39
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.40
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.57
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.70
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.04
|
| Rate for Payer: Zelis Worker's Compensation |
$8.53
|
|
|
MAGNESIUM UA POP
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2299380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$12.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.53
|
|
|
MAGNESIUM (Vitros)
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2232225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$12.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: GEHA Medicare |
$6.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$7.37
|
| Rate for Payer: Humana Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.70
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.39
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.40
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.57
|
| Rate for Payer: United Healthcare Commercial |
$94.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.70
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Medicare |
$5.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.04
|
| Rate for Payer: Zelis Worker's Compensation |
$8.53
|
|
|
MAGNESIUM (Vitros)
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2232225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$12.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.53
|
|
|
MALE SLING PROCEDURE
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 53440
|
| Hospital Charge Code |
6153440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.88 |
| Max. Negotiated Rate |
$1,471.55 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$1,316.65
|
| Rate for Payer: First Health Commercial |
$1,394.10
|
| Rate for Payer: First Health Workers Compensation |
$598.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,394.10
|
| Rate for Payer: GEHA Commercial |
$1,084.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,394.10
|
| Rate for Payer: Multiplan All |
$1,409.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,084.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,394.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,471.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,161.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,440.57
|
| Rate for Payer: Zelis Auto |
$619.60
|
| Rate for Payer: Zelis Worker's Compensation |
$422.88
|
|
|
MALE SLING PROCEDURE
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 53440
|
| Hospital Charge Code |
6153440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.88 |
| Max. Negotiated Rate |
$24,673.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,917.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$929.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,917.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,856.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,336.82
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$1,316.65
|
| Rate for Payer: First Health Commercial |
$1,394.10
|
| Rate for Payer: First Health Workers Compensation |
$598.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,394.10
|
| Rate for Payer: GEHA Commercial |
$1,239.20
|
| Rate for Payer: GEHA Medicare |
$12,336.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,394.10
|
| Rate for Payer: Humana ChoiceCare |
$13,570.50
|
| Rate for Payer: Humana Medicare Advantage |
$12,336.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,725.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,016.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,336.82
|
| Rate for Payer: Multiplan All |
$1,409.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,972.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,084.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,394.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,256.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,016.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,336.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,471.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,673.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,161.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,090.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,016.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,336.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,440.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,336.82
|
| Rate for Payer: Zelis Auto |
$619.60
|
| Rate for Payer: Zelis Medicare |
$10,486.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,804.18
|
| Rate for Payer: Zelis Worker's Compensation |
$422.88
|
|
|
MAM 2D DIAGNOSTIC BILATERAL
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
2408011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$144.68 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$204.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$485.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: Zelis Auto |
$277.60
|
| Rate for Payer: Zelis Worker's Compensation |
$144.68
|
|
|
MAM 2D DIAGNOSTIC BILATERAL
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
2408011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$144.68 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$416.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$188.45
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$204.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$555.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| Rate for Payer: Humana ChoiceCare |
$180.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$192.29
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$416.40
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$222.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$192.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$610.72
|
| Rate for Payer: United Healthcare Commercial |
$589.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: Zelis Auto |
$277.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$347.00
|
| Rate for Payer: Zelis Worker's Compensation |
$144.68
|
|
|
MAM 2D SCREEN BILATERAL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
2408010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$116.58 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$164.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$332.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$116.58
|
|
|
MAM 2D SCREEN BILATERAL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
2408010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$116.58 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$191.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$191.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$151.64
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$164.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$380.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Humana ChoiceCare |
$123.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.73
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$285.00
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$178.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$154.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$418.00
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$154.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.50
|
| Rate for Payer: Zelis Worker's Compensation |
$116.58
|
|
|
MAM 2D UNILATERAL LEFT
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2408013
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$149.24
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$152.28
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$152.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$460.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$152.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM 2D UNILATERAL LEFT
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2408013
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM 2D UNILATERAL RIGHT
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2408012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$149.24
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$152.28
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$152.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$460.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$152.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM 2D UNILATERAL RIGHT
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2408012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM 3D DIAGNOSTIC BILAT COMBO
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
2766917
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$197.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$139.94
|
|
|
MAM 3D DIAGNOSTIC BILAT COMBO
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
2766917
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$197.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$72.28
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.80
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$244.64
|
| Rate for Payer: United Healthcare Commercial |
$236.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.00
|
| Rate for Payer: Zelis Worker's Compensation |
$139.94
|
|
|
MAM 3D SCREENING BILAT COMBO
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
2766916
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$179.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.21
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$254.15
|
| Rate for Payer: First Health Commercial |
$269.10
|
| Rate for Payer: First Health Workers Compensation |
$65.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$269.10
|
| Rate for Payer: GEHA Commercial |
$239.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$269.10
|
| Rate for Payer: Humana ChoiceCare |
$77.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.78
|
| Rate for Payer: Multiplan All |
$272.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$179.40
|
| Rate for Payer: OMNI Networks Commercial |
$209.30
|
| Rate for Payer: One Health Plan PPO/POS |
$269.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$33.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$284.05
|
| Rate for Payer: Three Rivers Provider Network All |
$224.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$263.12
|
| Rate for Payer: United Healthcare Commercial |
$254.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$278.07
|
| Rate for Payer: Zelis Auto |
$119.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.50
|
| Rate for Payer: Zelis Worker's Compensation |
$46.31
|
|
|
MAM 3D SCREENING BILAT COMBO
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
2766916
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$254.15
|
| Rate for Payer: First Health Commercial |
$269.10
|
| Rate for Payer: First Health Workers Compensation |
$65.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$269.10
|
| Rate for Payer: GEHA Commercial |
$209.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$269.10
|
| Rate for Payer: Multiplan All |
$272.09
|
| Rate for Payer: OMNI Networks Commercial |
$209.30
|
| Rate for Payer: One Health Plan PPO/POS |
$269.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$284.05
|
| Rate for Payer: Three Rivers Provider Network All |
$224.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$278.07
|
| Rate for Payer: Zelis Auto |
$119.60
|
| Rate for Payer: Zelis Worker's Compensation |
$46.31
|
|
|
MAM 3D UNILATERAL LEFT COMBO HD
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
2766919
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$189.53 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$169.57
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: First Health Workers Compensation |
$156.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.55
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.55
|
| Rate for Payer: Humana ChoiceCare |
$51.87
|
| Rate for Payer: Multiplan All |
$181.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.70
|
| Rate for Payer: OMNI Networks Commercial |
$139.65
|
| Rate for Payer: One Health Plan PPO/POS |
$179.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.53
|
| Rate for Payer: Three Rivers Provider Network All |
$149.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$169.57
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.53
|
| Rate for Payer: Zelis Auto |
$79.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.75
|
| Rate for Payer: Zelis Worker's Compensation |
$110.68
|
|
