|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
20300145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
1999249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$318.75
|
| Rate for Payer: First Health Commercial |
$337.50
|
| Rate for Payer: First Health Workers Compensation |
$144.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$337.50
|
| Rate for Payer: GEHA Commercial |
$262.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$337.50
|
| Rate for Payer: Multiplan All |
$341.25
|
| Rate for Payer: OMNI Networks Commercial |
$262.50
|
| Rate for Payer: One Health Plan PPO/POS |
$337.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$356.25
|
| Rate for Payer: Three Rivers Provider Network All |
$281.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$348.75
|
| Rate for Payer: Zelis Auto |
$150.00
|
| Rate for Payer: Zelis Worker's Compensation |
$102.38
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
21600215
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
21600215
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$134.82
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
7211103
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$128.08 |
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$114.60
|
| Rate for Payer: First Health Commercial |
$121.34
|
| Rate for Payer: First Health Workers Compensation |
$52.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$121.34
|
| Rate for Payer: GEHA Commercial |
$94.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$121.34
|
| Rate for Payer: Multiplan All |
$122.69
|
| Rate for Payer: OMNI Networks Commercial |
$94.37
|
| Rate for Payer: One Health Plan PPO/POS |
$121.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$128.08
|
| Rate for Payer: Three Rivers Provider Network All |
$101.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$125.38
|
| Rate for Payer: Zelis Auto |
$53.93
|
| Rate for Payer: Zelis Worker's Compensation |
$36.81
|
|
|
TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESIO
|
Facility
|
IP
|
$134.82
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
8511116
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$128.08 |
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$114.60
|
| Rate for Payer: First Health Commercial |
$121.34
|
| Rate for Payer: First Health Workers Compensation |
$52.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$121.34
|
| Rate for Payer: GEHA Commercial |
$94.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$121.34
|
| Rate for Payer: Multiplan All |
$122.69
|
| Rate for Payer: OMNI Networks Commercial |
$94.37
|
| Rate for Payer: One Health Plan PPO/POS |
$121.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$128.08
|
| Rate for Payer: Three Rivers Provider Network All |
$101.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$125.38
|
| Rate for Payer: Zelis Auto |
$53.93
|
| Rate for Payer: Zelis Worker's Compensation |
$36.81
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$268.23
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
8511115
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: First Health Commercial |
$241.41
|
| Rate for Payer: First Health Workers Compensation |
$103.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.41
|
| Rate for Payer: GEHA Commercial |
$214.58
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.41
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$244.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$187.76
|
| Rate for Payer: One Health Plan PPO/POS |
$241.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$201.17
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$107.29
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$73.23
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
20300144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
21600212
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$268.23
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
7211102
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: First Health Commercial |
$241.41
|
| Rate for Payer: First Health Workers Compensation |
$103.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.41
|
| Rate for Payer: GEHA Commercial |
$214.58
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.41
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$244.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$187.76
|
| Rate for Payer: One Health Plan PPO/POS |
$241.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$201.17
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$107.29
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$73.23
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$730.37
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
6111102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$693.85 |
| Rate for Payer: Cash Price |
$438.22
|
| Rate for Payer: Cigna Commercial |
$620.81
|
| Rate for Payer: First Health Commercial |
$657.33
|
| Rate for Payer: First Health Workers Compensation |
$282.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.33
|
| Rate for Payer: GEHA Commercial |
$511.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.33
|
| Rate for Payer: Multiplan All |
$664.64
|
| Rate for Payer: OMNI Networks Commercial |
$511.26
|
| Rate for Payer: One Health Plan PPO/POS |
$657.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.85
|
| Rate for Payer: Three Rivers Provider Network All |
$547.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.24
|
| Rate for Payer: Zelis Auto |
$292.15
|
| Rate for Payer: Zelis Worker's Compensation |
$199.39
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
23500059
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
23500059
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
20300144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
21600212
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$730.37
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
6111102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$693.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$438.22
|
| Rate for Payer: Cash Price |
$438.22
|
| Rate for Payer: Cigna Commercial |
$620.81
|
| Rate for Payer: First Health Commercial |
$657.33
|
| Rate for Payer: First Health Workers Compensation |
$282.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.33
|
| Rate for Payer: GEHA Commercial |
$584.30
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.33
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$664.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$511.26
|
| Rate for Payer: One Health Plan PPO/POS |
$657.33
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$547.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$292.15
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$199.39
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$492.00
|
|
| Hospital Charge Code |
8111102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$268.23
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
8511115
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$254.82 |
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: First Health Commercial |
$241.41
|
| Rate for Payer: First Health Workers Compensation |
$103.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.41
|
| Rate for Payer: GEHA Commercial |
$187.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.41
|
| Rate for Payer: Multiplan All |
$244.09
|
| Rate for Payer: OMNI Networks Commercial |
$187.76
|
| Rate for Payer: One Health Plan PPO/POS |
$241.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.82
|
| Rate for Payer: Three Rivers Provider Network All |
$201.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.45
|
| Rate for Payer: Zelis Auto |
$107.29
|
| Rate for Payer: Zelis Worker's Compensation |
$73.23
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$492.00
|
|
| Hospital Charge Code |
8111102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$393.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Humana ChoiceCare |
$127.92
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$295.20
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$432.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$246.00
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
1999248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.29 |
| Max. Negotiated Rate |
$703.95 |
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$629.85
|
| Rate for Payer: First Health Commercial |
$666.90
|
| Rate for Payer: First Health Workers Compensation |
$286.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$666.90
|
| Rate for Payer: GEHA Commercial |
$518.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$666.90
|
| Rate for Payer: Multiplan All |
$674.31
|
| Rate for Payer: OMNI Networks Commercial |
$518.70
|
| Rate for Payer: One Health Plan PPO/POS |
$666.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$703.95
|
| Rate for Payer: Three Rivers Provider Network All |
$555.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$689.13
|
| Rate for Payer: Zelis Auto |
$296.40
|
| Rate for Payer: Zelis Worker's Compensation |
$202.29
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
1999248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$703.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$444.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$264.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$629.85
|
| Rate for Payer: First Health Commercial |
$666.90
|
| Rate for Payer: First Health Workers Compensation |
$286.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$666.90
|
| Rate for Payer: GEHA Commercial |
$592.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$666.90
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$674.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$518.70
|
| Rate for Payer: One Health Plan PPO/POS |
$666.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$247.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$703.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$555.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$689.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$296.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$202.29
|
|
|
TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$268.23
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
7211102
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$73.23 |
| Max. Negotiated Rate |
$254.82 |
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: First Health Commercial |
$241.41
|
| Rate for Payer: First Health Workers Compensation |
$103.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.41
|
| Rate for Payer: GEHA Commercial |
$187.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.41
|
| Rate for Payer: Multiplan All |
$244.09
|
| Rate for Payer: OMNI Networks Commercial |
$187.76
|
| Rate for Payer: One Health Plan PPO/POS |
$241.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.82
|
| Rate for Payer: Three Rivers Provider Network All |
$201.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.45
|
| Rate for Payer: Zelis Auto |
$107.29
|
| Rate for Payer: Zelis Worker's Compensation |
$73.23
|
|
|
TAP BLOCK BILATERAL BY INJECTION(S)
|
Facility
|
IP
|
$4,466.00
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
3764488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$4,242.70 |
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cigna Commercial |
$3,796.10
|
| Rate for Payer: First Health Commercial |
$4,019.40
|
| Rate for Payer: First Health Workers Compensation |
$1,724.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,019.40
|
| Rate for Payer: GEHA Commercial |
$3,126.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,019.40
|
| Rate for Payer: Multiplan All |
$4,064.06
|
| Rate for Payer: OMNI Networks Commercial |
$3,126.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,019.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,242.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,153.38
|
| Rate for Payer: Zelis Auto |
$1,786.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,219.22
|
|
|
TAP BLOCK BILATERAL BY INJECTION(S)
|
Facility
|
OP
|
$4,466.00
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
3764488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.19 |
| Max. Negotiated Rate |
$4,242.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,679.60
|
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cigna Commercial |
$3,796.10
|
| Rate for Payer: First Health Commercial |
$4,019.40
|
| Rate for Payer: First Health Workers Compensation |
$403.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,019.40
|
| Rate for Payer: GEHA Commercial |
$3,572.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,019.40
|
| Rate for Payer: Humana ChoiceCare |
$1,161.16
|
| Rate for Payer: Multiplan All |
$4,064.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,679.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,126.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,019.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,242.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,349.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,930.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,116.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,153.38
|
| Rate for Payer: Zelis Auto |
$1,786.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,233.00
|
| Rate for Payer: Zelis Worker's Compensation |
$285.19
|
|
|
TAPENTADOL (NUCYNTA) 100MG
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 24510011660
|
| Hospital Charge Code |
3302408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$34.32
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.20
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$116.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
