|
min inhibitory conc(MIC),1drug REF096388
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2200714
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.57
|
| 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 |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.65
|
| 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 |
$13.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: GEHA Medicare |
$8.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$9.52
|
| Rate for Payer: Humana Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.65
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.71
|
| 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 |
$14.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.30
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$158.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.65
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Medicare |
$7.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.38
|
| Rate for Payer: Zelis Worker's Compensation |
$9.50
|
|
|
MINOCYCLINE HCL 100 MG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 13668048450
|
| Hospital Charge Code |
3302866
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
MINOCYCLINE HCL 100 MG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 13668048450
|
| Hospital Charge Code |
3302866
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
MIN OIL/PET/PHENYLEPHRINE 2.5MG/GR OINT
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00573287110
|
| Hospital Charge Code |
3300715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
MIN OIL/PET/PHENYLEPHRINE 2.5MG/GR OINT
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00573287110
|
| Hospital Charge Code |
3300715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
MINOXIDIL 2.5 MG
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084020401
|
| Hospital Charge Code |
3302913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
MINOXIDIL 2.5 MG
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084020401
|
| Hospital Charge Code |
3302913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
MIRALAX POWDER- 17GM
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904693176
|
| Hospital Charge Code |
3300729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
MIRALAX POWDER- 17GM
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904693176
|
| Hospital Charge Code |
3300729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
MIRTAZAPINE TAB 15MG
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
3300609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$15.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
MIRTAZAPINE TAB 15MG
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
3300609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$17.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Humana ChoiceCare |
$5.72
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.20
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
MISOPROSTOL TAB 100MCG
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
3300610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
MISOPROSTOL TAB 100MCG
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
3300610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
mitochondrial (m2) ab REF006650
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2205961
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
mitochondrial (m2) ab REF006650
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2205961
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
MITOMYCIN 40MG
|
Facility
|
IP
|
$4,128.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3305008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,126.94 |
| Max. Negotiated Rate |
$3,921.60 |
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$3,508.80
|
| Rate for Payer: First Health Commercial |
$3,715.20
|
| Rate for Payer: First Health Workers Compensation |
$1,593.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,715.20
|
| Rate for Payer: GEHA Commercial |
$2,889.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,715.20
|
| Rate for Payer: Multiplan All |
$3,756.48
|
| Rate for Payer: OMNI Networks Commercial |
$2,889.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,715.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,921.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,096.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,839.04
|
| Rate for Payer: Zelis Auto |
$1,651.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,126.94
|
|
|
MITOMYCIN 40MG
|
Facility
|
OP
|
$4,128.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3305008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$3,921.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,476.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$3,508.80
|
| Rate for Payer: First Health Commercial |
$3,715.20
|
| Rate for Payer: First Health Workers Compensation |
$1,593.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,715.20
|
| Rate for Payer: GEHA Commercial |
$22.39
|
| Rate for Payer: GEHA Medicare |
$20.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,715.20
|
| Rate for Payer: Humana ChoiceCare |
$22.39
|
| Rate for Payer: Humana Medicare Advantage |
$20.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$79.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.35
|
| Rate for Payer: Multiplan All |
$3,756.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,889.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,715.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$79.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,921.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,096.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,839.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.35
|
| Rate for Payer: Zelis Auto |
$1,651.20
|
| Rate for Payer: Zelis Medicare |
$17.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.42
|
| Rate for Payer: Zelis Worker's Compensation |
$1,126.94
|
|
|
MITOMYCIN 40MG INTRAVESICLE
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3301232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$623.53 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: First Health Workers Compensation |
$881.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,598.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
| Rate for Payer: Zelis Worker's Compensation |
$623.53
|
|
|
MITOMYCIN 40MG INTRAVESICLE
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT J9280
|
| Hospital Charge Code |
3301232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,370.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$98.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: First Health Workers Compensation |
$881.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$22.39
|
| Rate for Payer: GEHA Medicare |
$20.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Humana ChoiceCare |
$22.39
|
| Rate for Payer: Humana Medicare Advantage |
$20.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$79.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.35
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$79.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.35
|
| Rate for Payer: Zelis Auto |
$913.60
|
| Rate for Payer: Zelis Medicare |
$17.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.42
|
| Rate for Payer: Zelis Worker's Compensation |
$623.53
|
|
|
MLT SLEEP LATENCY/MAINT WAKEFULNESS TSTG
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$724.54 |
| Max. Negotiated Rate |
$2,521.30 |
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cigna Commercial |
$2,255.90
|
| Rate for Payer: First Health Commercial |
$2,388.60
|
| Rate for Payer: First Health Workers Compensation |
$1,024.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,388.60
|
| Rate for Payer: GEHA Commercial |
$1,857.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,388.60
|
| Rate for Payer: Multiplan All |
$2,415.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,857.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,388.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,521.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,990.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,468.22
|
| Rate for Payer: Zelis Auto |
$1,061.60
|
| Rate for Payer: Zelis Worker's Compensation |
$724.54
|
|
|
MLT SLEEP LATENCY/MAINT WAKEFULNESS TSTG
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$428.26 |
| Max. Negotiated Rate |
$2,521.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,155.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,592.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,155.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$915.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cash Price |
$1,592.40
|
| Rate for Payer: Cigna Commercial |
$2,255.90
|
| Rate for Payer: First Health Commercial |
$2,388.60
|
| Rate for Payer: First Health Workers Compensation |
$1,024.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,388.60
|
| Rate for Payer: GEHA Commercial |
$2,123.20
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,388.60
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$934.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$2,415.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,857.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,388.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,078.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$934.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,521.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$1,990.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$934.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,468.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$1,061.60
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$724.54
|
|
|
MM DIAG DIGTL MAMO UNIL
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2760082
|
|
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
|
|
|
MM DIAG DIGTL MAMO UNIL
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2760082
|
|
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
|
|
|
MM MAMMO 3D IMPLANTS DX COMBO HD
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
2766921
|
|
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
|
|
|
MM MAMMO 3D IMPLANTS DX COMBO HD
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
2766921
|
|
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
|
|
