|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
7664480
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$238.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
6164484
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
7664484
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
6164484
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
21900151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
21900151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
21764484
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
21764484
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL L/S EA LV
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
7664484
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
8164400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.72 |
| Max. Negotiated Rate |
$1,227.40 |
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$1,098.20
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: First Health Workers Compensation |
$498.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,162.80
|
| Rate for Payer: GEHA Commercial |
$904.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,162.80
|
| Rate for Payer: Multiplan All |
$1,175.72
|
| Rate for Payer: OMNI Networks Commercial |
$904.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,227.40
|
| Rate for Payer: Three Rivers Provider Network All |
$969.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,201.56
|
| Rate for Payer: Zelis Auto |
$516.80
|
| Rate for Payer: Zelis Worker's Compensation |
$352.72
|
|
|
NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
8164400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.00 |
| Max. Negotiated Rate |
$1,227.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$1,098.20
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: First Health Workers Compensation |
$498.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,162.80
|
| Rate for Payer: GEHA Commercial |
$1,033.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,162.80
|
| Rate for Payer: Humana ChoiceCare |
$335.92
|
| Rate for Payer: Multiplan All |
$1,175.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$775.20
|
| Rate for Payer: OMNI Networks Commercial |
$904.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,227.40
|
| Rate for Payer: Three Rivers Provider Network All |
$969.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,136.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$323.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,201.56
|
| Rate for Payer: Zelis Auto |
$516.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$646.00
|
| Rate for Payer: Zelis Worker's Compensation |
$352.72
|
|
|
NJX CNTRST KNE ARTHG/CT/MR
|
Facility
|
OP
|
$507.24
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
6127369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.81 |
| Max. Negotiated Rate |
$481.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.34
|
| Rate for Payer: Cash Price |
$304.34
|
| Rate for Payer: Cigna Commercial |
$431.15
|
| Rate for Payer: First Health Commercial |
$456.52
|
| Rate for Payer: First Health Workers Compensation |
$195.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$456.52
|
| Rate for Payer: GEHA Commercial |
$405.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$456.52
|
| Rate for Payer: Humana ChoiceCare |
$131.88
|
| Rate for Payer: Multiplan All |
$461.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.34
|
| Rate for Payer: OMNI Networks Commercial |
$355.07
|
| Rate for Payer: One Health Plan PPO/POS |
$456.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$481.88
|
| Rate for Payer: Three Rivers Provider Network All |
$380.43
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$446.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$471.73
|
| Rate for Payer: Zelis Auto |
$202.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$253.62
|
| Rate for Payer: Zelis Worker's Compensation |
$138.48
|
|
|
NJX CNTRST KNE ARTHG/CT/MR
|
Facility
|
IP
|
$507.24
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
6127369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.48 |
| Max. Negotiated Rate |
$481.88 |
| Rate for Payer: Cash Price |
$304.34
|
| Rate for Payer: Cigna Commercial |
$431.15
|
| Rate for Payer: First Health Commercial |
$456.52
|
| Rate for Payer: First Health Workers Compensation |
$195.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$456.52
|
| Rate for Payer: GEHA Commercial |
$355.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$456.52
|
| Rate for Payer: Multiplan All |
$461.59
|
| Rate for Payer: OMNI Networks Commercial |
$355.07
|
| Rate for Payer: One Health Plan PPO/POS |
$456.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$481.88
|
| Rate for Payer: Three Rivers Provider Network All |
$380.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$471.73
|
| Rate for Payer: Zelis Auto |
$202.90
|
| Rate for Payer: Zelis Worker's Compensation |
$138.48
|
|
|
NJX CNTRST KNE ARTHG/CT/MRI
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
2400110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.35 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$672.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Worker's Compensation |
$262.35
|
|
|
NJX CNTRST KNE ARTHG/CT/MRI
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
2400110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.25 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$522.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$768.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Humana ChoiceCare |
$249.86
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.60
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$240.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$480.50
|
| Rate for Payer: Zelis Worker's Compensation |
$369.60
|
|
|
NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9200014
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
6154235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
6154235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9200014
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
21900110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$452.80
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
6164490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.54 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$278.80
|
| Rate for Payer: First Health Commercial |
$295.20
|
| Rate for Payer: First Health Workers Compensation |
$126.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$295.20
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$295.20
|
| Rate for Payer: Multiplan All |
$298.48
|
| Rate for Payer: OMNI Networks Commercial |
$229.60
|
| Rate for Payer: One Health Plan PPO/POS |
$295.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$311.60
|
| Rate for Payer: Three Rivers Provider Network All |
$246.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.04
|
| Rate for Payer: Zelis Auto |
$131.20
|
| Rate for Payer: Zelis Worker's Compensation |
$89.54
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
21700001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$452.80
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
7664490
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$396.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
21900110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$396.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
21700001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$396.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
