|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
CPT 25670
|
| Hospital Charge Code |
6125670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.15 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$1,049.75
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: First Health Workers Compensation |
$476.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,111.50
|
| Rate for Payer: GEHA Commercial |
$988.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,111.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,123.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$864.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,111.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,173.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$926.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,148.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$494.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$337.15
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
6125675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$597.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
6125660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$698.70
|
| Rate for Payer: First Health Commercial |
$739.80
|
| Rate for Payer: First Health Workers Compensation |
$317.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$739.80
|
| Rate for Payer: GEHA Commercial |
$657.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$739.80
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$748.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$575.40
|
| Rate for Payer: One Health Plan PPO/POS |
$739.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$780.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$616.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$764.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$328.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$224.41
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
6125690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.90 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$674.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: Zelis Auto |
$385.20
|
| Rate for Payer: Zelis Worker's Compensation |
$262.90
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT 25695
|
| Hospital Charge Code |
6125695
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.54 |
| Max. Negotiated Rate |
$1,230.25 |
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,100.75
|
| Rate for Payer: First Health Commercial |
$1,165.50
|
| Rate for Payer: First Health Workers Compensation |
$500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,165.50
|
| Rate for Payer: GEHA Commercial |
$906.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,165.50
|
| Rate for Payer: Multiplan All |
$1,178.45
|
| Rate for Payer: OMNI Networks Commercial |
$906.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,165.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,230.25
|
| Rate for Payer: Three Rivers Provider Network All |
$971.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,204.35
|
| Rate for Payer: Zelis Auto |
$518.00
|
| Rate for Payer: Zelis Worker's Compensation |
$353.54
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 25676
|
| Hospital Charge Code |
6125676
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.62 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$766.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cigna Commercial |
$1,085.45
|
| Rate for Payer: First Health Commercial |
$1,149.30
|
| Rate for Payer: First Health Workers Compensation |
$493.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,149.30
|
| Rate for Payer: GEHA Commercial |
$1,021.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,149.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,162.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$893.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,149.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,213.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$957.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,187.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$510.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$348.62
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$1,235.00
|
|
|
Service Code
|
CPT 25670
|
| Hospital Charge Code |
6125670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.15 |
| Max. Negotiated Rate |
$1,173.25 |
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$1,049.75
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: First Health Workers Compensation |
$476.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,111.50
|
| Rate for Payer: GEHA Commercial |
$864.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,111.50
|
| Rate for Payer: Multiplan All |
$1,123.85
|
| Rate for Payer: OMNI Networks Commercial |
$864.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,111.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,173.25
|
| Rate for Payer: Three Rivers Provider Network All |
$926.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,148.55
|
| Rate for Payer: Zelis Auto |
$494.00
|
| Rate for Payer: Zelis Worker's Compensation |
$337.15
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
6125675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 25685
|
| Hospital Charge Code |
6125685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$579.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,200.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,365.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$600.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$409.50
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
6125680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$909.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$813.45
|
| Rate for Payer: First Health Commercial |
$861.30
|
| Rate for Payer: First Health Workers Compensation |
$369.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$861.30
|
| Rate for Payer: GEHA Commercial |
$765.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$861.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$870.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$669.90
|
| Rate for Payer: One Health Plan PPO/POS |
$861.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$909.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$717.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$382.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$261.26
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
6125680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.26 |
| Max. Negotiated Rate |
$909.15 |
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$813.45
|
| Rate for Payer: First Health Commercial |
$861.30
|
| Rate for Payer: First Health Workers Compensation |
$369.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$861.30
|
| Rate for Payer: GEHA Commercial |
$669.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$861.30
|
| Rate for Payer: Multiplan All |
$870.87
|
| Rate for Payer: OMNI Networks Commercial |
$669.90
|
| Rate for Payer: One Health Plan PPO/POS |
$861.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$909.15
|
| Rate for Payer: Three Rivers Provider Network All |
$717.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.01
|
| Rate for Payer: Zelis Auto |
$382.80
|
| Rate for Payer: Zelis Worker's Compensation |
$261.26
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 25685
|
| Hospital Charge Code |
6125685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$579.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,050.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| Rate for Payer: Multiplan All |
$1,365.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.00
|
| Rate for Payer: Zelis Auto |
$600.00
|
| Rate for Payer: Zelis Worker's Compensation |
$409.50
|
|
|
treponema pallidum abs TP-PA REF082370
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
2247390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$20.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$77.60
|
| Rate for Payer: GEHA Medicare |
$13.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Humana ChoiceCare |
$14.56
|
| Rate for Payer: Humana Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.24
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.51
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.48
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$82.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.24
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Medicare |
$11.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.89
|
| Rate for Payer: Zelis Worker's Compensation |
$14.35
|
|
|
treponema pallidum abs TP-PA REF082370
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
2247390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$20.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$67.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.35
|
|
|
TRIAMCIN 0.1% 15GM/LUBRIDERM
|
Facility
|
OP
|
$126.00
|
|
| Hospital Charge Code |
3300923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$32.76
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$75.60
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$110.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.00
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
TRIAMCIN 0.1% 15GM/LUBRIDERM
|
Facility
|
IP
|
$126.00
|
|
| Hospital Charge Code |
3300923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
TRIAMCIN 0.5% 30GM/LUBRIDERM
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3300922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
TRIAMCIN 0.5% 30GM/LUBRIDERM
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3300922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$33.28
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.80
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$112.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
TRIAMCINOLONE CREAM 0.1% 15GM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
3300917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$31.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$10.14
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.40
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
TRIAMCINOLONE CREAM 0.1% 15GM
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
3300917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$27.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
TRIAMCINOLONE/LUBRIDERM 0.1% 30GM/480ML
|
Facility
|
IP
|
$457.00
|
|
| Hospital Charge Code |
3300920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
TRIAMCINOLONE/LUBRIDERM 0.1% 30GM/480ML
|
Facility
|
OP
|
$457.00
|
|
| Hospital Charge Code |
3300920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$118.82
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$274.20
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$402.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$228.50
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
TRIAMCINOLONE/LUBRIDRM COMPOND 0.5% IN 8
|
Facility
|
OP
|
$126.00
|
|
| Hospital Charge Code |
3300921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$32.76
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$75.60
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$110.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.00
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
TRIAMCINOLONE/LUBRIDRM COMPOND 0.5% IN 8
|
Facility
|
IP
|
$126.00
|
|
| Hospital Charge Code |
3300921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
TRIAMCINOLONE OINT 0.1% - 15GM
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
3300919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$27.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
