|
DAKIN'S SOLUTION 0.5%
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
NDC 39328006250
|
| Hospital Charge Code |
3300218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
DANTROLENE SODIUM FOR IV SOLN 20MG
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
3300219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$289.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
DANTROLENE SODIUM FOR IV SOLN 20MG
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
NDC 42023012306
|
| Hospital Charge Code |
3300219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$159.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Humana ChoiceCare |
$107.38
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$247.80
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$363.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$206.50
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
DAPTOMYCIN 350 MG INJ VIAL
|
Facility
|
OP
|
$117.12
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
3303190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$0.84
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cigna Commercial |
$99.55
|
| Rate for Payer: First Health Commercial |
$105.41
|
| Rate for Payer: First Health Workers Compensation |
$45.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.41
|
| Rate for Payer: GEHA Commercial |
$0.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.41
|
| Rate for Payer: Humana ChoiceCare |
$30.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$0.86
|
| Rate for Payer: Multiplan All |
$106.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.27
|
| Rate for Payer: OMNI Networks Commercial |
$81.98
|
| Rate for Payer: One Health Plan PPO/POS |
$105.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$0.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$0.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.26
|
| Rate for Payer: Three Rivers Provider Network All |
$87.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$103.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.92
|
| Rate for Payer: Zelis Auto |
$46.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.56
|
| Rate for Payer: Zelis Worker's Compensation |
$31.97
|
|
|
DAPTOMYCIN 350 MG INJ VIAL
|
Facility
|
IP
|
$117.12
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
3303190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Cash Price |
$70.27
|
| Rate for Payer: Cigna Commercial |
$99.55
|
| Rate for Payer: First Health Commercial |
$105.41
|
| Rate for Payer: First Health Workers Compensation |
$45.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.41
|
| Rate for Payer: GEHA Commercial |
$81.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.41
|
| Rate for Payer: Multiplan All |
$106.58
|
| Rate for Payer: OMNI Networks Commercial |
$81.98
|
| Rate for Payer: One Health Plan PPO/POS |
$105.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.26
|
| Rate for Payer: Three Rivers Provider Network All |
$87.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.92
|
| Rate for Payer: Zelis Auto |
$46.85
|
| Rate for Payer: Zelis Worker's Compensation |
$31.97
|
|
|
DAPTOMYCIN 500 MG INJ VIAL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
3300220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
DAPTOMYCIN 500 MG INJ VIAL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
3300220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$0.84
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$0.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$36.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$0.86
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.00
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$0.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$0.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$123.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
DB OP WND EACH ADD'L 20 CM - PROFEE
|
Facility
|
OP
|
$651.50
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9600126
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$618.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$553.77
|
| Rate for Payer: First Health Commercial |
$586.35
|
| Rate for Payer: First Health Workers Compensation |
$251.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.35
|
| Rate for Payer: GEHA Commercial |
$521.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.35
|
| Rate for Payer: Humana ChoiceCare |
$169.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$592.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.90
|
| Rate for Payer: OMNI Networks Commercial |
$456.05
|
| Rate for Payer: One Health Plan PPO/POS |
$586.35
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$618.92
|
| Rate for Payer: Three Rivers Provider Network All |
$488.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$573.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$605.89
|
| Rate for Payer: Zelis Auto |
$260.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$325.75
|
| Rate for Payer: Zelis Worker's Compensation |
$177.86
|
|
|
DB OP WND EACH ADD'L 20 CM - PROFEE
|
Facility
|
IP
|
$651.50
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9600126
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$618.92 |
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$553.77
|
| Rate for Payer: First Health Commercial |
$586.35
|
| Rate for Payer: First Health Workers Compensation |
$251.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.35
|
| Rate for Payer: GEHA Commercial |
$456.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.35
|
| Rate for Payer: Multiplan All |
$592.87
|
| Rate for Payer: OMNI Networks Commercial |
$456.05
|
| Rate for Payer: One Health Plan PPO/POS |
$586.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$618.92
|
| Rate for Payer: Three Rivers Provider Network All |
$488.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$605.89
|
| Rate for Payer: Zelis Auto |
$260.60
|
| Rate for Payer: Zelis Worker's Compensation |
$177.86
|
|
|
DBRDMNT BONE MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$902.88
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
6111044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.49 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$541.73
|
| Rate for Payer: Cash Price |
$541.73
|
| Rate for Payer: Cigna Commercial |
$767.45
|
| Rate for Payer: First Health Commercial |
$812.59
|
| Rate for Payer: First Health Workers Compensation |
$348.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.59
|
| Rate for Payer: GEHA Commercial |
$722.30
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.59
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$821.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$632.02
|
| Rate for Payer: One Health Plan PPO/POS |
$812.59
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.74
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$677.16
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$361.15
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$246.49
|
|
|
DBRDMNT BONE MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$902.88
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
6111044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.49 |
| Max. Negotiated Rate |
$857.74 |
| Rate for Payer: Cash Price |
$541.73
|
| Rate for Payer: Cigna Commercial |
$767.45
|
| Rate for Payer: First Health Commercial |
$812.59
|
| Rate for Payer: First Health Workers Compensation |
$348.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.59
|
| Rate for Payer: GEHA Commercial |
$632.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.59
|
| Rate for Payer: Multiplan All |
$821.62
|
| Rate for Payer: OMNI Networks Commercial |
$632.02
|
| Rate for Payer: One Health Plan PPO/POS |
$812.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.74
|
| Rate for Payer: Three Rivers Provider Network All |
$677.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.68
|
| Rate for Payer: Zelis Auto |
$361.15
|
| Rate for Payer: Zelis Worker's Compensation |
$246.49
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
20300005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$5,189.41
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9611044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$4,929.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,113.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,113.65
|
| Rate for Payer: Cash Price |
$3,113.65
|
| Rate for Payer: Cigna Commercial |
$4,411.00
|
| Rate for Payer: First Health Commercial |
$4,670.47
|
| Rate for Payer: First Health Workers Compensation |
$2,003.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,670.47
|
| Rate for Payer: GEHA Commercial |
$4,151.53
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,670.47
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,722.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,632.59
|
| Rate for Payer: One Health Plan PPO/POS |
$4,670.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,929.94
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,892.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,826.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,075.76
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,416.71
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$5,257.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
1900005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$4,994.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,154.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,154.20
|
| Rate for Payer: Cash Price |
$3,154.20
|
| Rate for Payer: Cigna Commercial |
$4,468.45
|
| Rate for Payer: First Health Commercial |
$4,731.30
|
| Rate for Payer: First Health Workers Compensation |
$2,029.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,731.30
|
| Rate for Payer: GEHA Commercial |
$4,205.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,731.30
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,783.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,679.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,731.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,994.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,942.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,889.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,102.80
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,435.16
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$5,189.41
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9611044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,416.71 |
| Max. Negotiated Rate |
$4,929.94 |
| Rate for Payer: Cash Price |
$3,113.65
|
| Rate for Payer: Cigna Commercial |
$4,411.00
|
| Rate for Payer: First Health Commercial |
$4,670.47
|
| Rate for Payer: First Health Workers Compensation |
$2,003.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,670.47
|
| Rate for Payer: GEHA Commercial |
$3,632.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,670.47
|
| Rate for Payer: Multiplan All |
$4,722.36
|
| Rate for Payer: OMNI Networks Commercial |
$3,632.59
|
| Rate for Payer: One Health Plan PPO/POS |
$4,670.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,929.94
|
| Rate for Payer: Three Rivers Provider Network All |
$3,892.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,826.15
|
| Rate for Payer: Zelis Auto |
$2,075.76
|
| Rate for Payer: Zelis Worker's Compensation |
$1,416.71
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$4,199.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
1000029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,146.33 |
| Max. Negotiated Rate |
$3,989.05 |
| Rate for Payer: Cash Price |
$2,519.40
|
| Rate for Payer: Cigna Commercial |
$3,569.15
|
| Rate for Payer: First Health Commercial |
$3,779.10
|
| Rate for Payer: First Health Workers Compensation |
$1,621.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,779.10
|
| Rate for Payer: GEHA Commercial |
$2,939.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,779.10
|
| Rate for Payer: Multiplan All |
$3,821.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,939.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,779.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,989.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,905.07
|
| Rate for Payer: Zelis Auto |
$1,679.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,146.33
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$5,257.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
1900005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.16 |
| Max. Negotiated Rate |
$4,994.15 |
| Rate for Payer: Cash Price |
$3,154.20
|
| Rate for Payer: Cigna Commercial |
$4,468.45
|
| Rate for Payer: First Health Commercial |
$4,731.30
|
| Rate for Payer: First Health Workers Compensation |
$2,029.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,731.30
|
| Rate for Payer: GEHA Commercial |
$3,679.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,731.30
|
| Rate for Payer: Multiplan All |
$4,783.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,679.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,731.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,994.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,942.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,889.01
|
| Rate for Payer: Zelis Auto |
$2,102.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,435.16
|
|
|
DBRDMNT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
20300005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$576.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$768.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
DBRDMNT MUSC AND/OR FASCIA 1ST 20CM
|
Facility
|
OP
|
$6,704.25
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
8111043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$6,369.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,022.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cigna Commercial |
$5,698.61
|
| Rate for Payer: First Health Commercial |
$6,033.82
|
| Rate for Payer: First Health Workers Compensation |
$2,588.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,033.82
|
| Rate for Payer: GEHA Commercial |
$5,363.40
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,033.82
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$6,100.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$4,692.98
|
| Rate for Payer: One Health Plan PPO/POS |
$6,033.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,369.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$5,028.19
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,234.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$2,681.70
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$1,830.26
|
|
|
DBRDMNT MUSC AND/OR FASCIA 1ST 20CM
|
Facility
|
IP
|
$3,388.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
9611043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.03 |
| Max. Negotiated Rate |
$3,218.97 |
| Rate for Payer: Cash Price |
$2,033.03
|
| Rate for Payer: Cigna Commercial |
$2,880.13
|
| Rate for Payer: First Health Commercial |
$3,049.55
|
| Rate for Payer: First Health Workers Compensation |
$1,308.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,049.55
|
| Rate for Payer: GEHA Commercial |
$2,371.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,049.55
|
| Rate for Payer: Multiplan All |
$3,083.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,371.87
|
| Rate for Payer: One Health Plan PPO/POS |
$3,049.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,218.97
|
| Rate for Payer: Three Rivers Provider Network All |
$2,541.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,151.20
|
| Rate for Payer: Zelis Auto |
$1,355.36
|
| Rate for Payer: Zelis Worker's Compensation |
$925.03
|
|
|
DBRDMNT MUSC AND/OR FASCIA 1ST 20CM
|
Facility
|
OP
|
$3,388.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
9611043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$3,218.97 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,033.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$2,033.03
|
| Rate for Payer: Cash Price |
$2,033.03
|
| Rate for Payer: Cigna Commercial |
$2,880.13
|
| Rate for Payer: First Health Commercial |
$3,049.55
|
| Rate for Payer: First Health Workers Compensation |
$1,308.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,049.55
|
| Rate for Payer: GEHA Commercial |
$2,710.71
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,049.55
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$3,083.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,371.87
|
| Rate for Payer: One Health Plan PPO/POS |
$3,049.55
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,218.97
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$2,541.29
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,151.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$1,355.36
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$925.03
|
|
|
DBRDMNT MUSC AND/OR FASCIA 1ST 20CM
|
Facility
|
IP
|
$6,704.25
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
8111043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,830.26 |
| Max. Negotiated Rate |
$6,369.04 |
| Rate for Payer: Cash Price |
$4,022.55
|
| Rate for Payer: Cigna Commercial |
$5,698.61
|
| Rate for Payer: First Health Commercial |
$6,033.82
|
| Rate for Payer: First Health Workers Compensation |
$2,588.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,033.82
|
| Rate for Payer: GEHA Commercial |
$4,692.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,033.82
|
| Rate for Payer: Multiplan All |
$6,100.87
|
| Rate for Payer: OMNI Networks Commercial |
$4,692.98
|
| Rate for Payer: One Health Plan PPO/POS |
$6,033.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,369.04
|
| Rate for Payer: Three Rivers Provider Network All |
$5,028.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,234.95
|
| Rate for Payer: Zelis Auto |
$2,681.70
|
| Rate for Payer: Zelis Worker's Compensation |
$1,830.26
|
|
|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
1000028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.46 |
| Max. Negotiated Rate |
$1,278.70 |
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$1,144.10
|
| Rate for Payer: First Health Commercial |
$1,211.40
|
| Rate for Payer: First Health Workers Compensation |
$519.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,211.40
|
| Rate for Payer: GEHA Commercial |
$942.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,211.40
|
| Rate for Payer: Multiplan All |
$1,224.86
|
| Rate for Payer: OMNI Networks Commercial |
$942.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,211.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,278.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,009.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,251.78
|
| Rate for Payer: Zelis Auto |
$538.40
|
| Rate for Payer: Zelis Worker's Compensation |
$367.46
|
|
|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
20300004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$87.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Worker's Compensation |
$61.70
|
|
|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$1,974.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
1900004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.90 |
| Max. Negotiated Rate |
$1,875.30 |
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna Commercial |
$1,677.90
|
| Rate for Payer: First Health Commercial |
$1,776.60
|
| Rate for Payer: First Health Workers Compensation |
$762.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,776.60
|
| Rate for Payer: GEHA Commercial |
$1,381.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,776.60
|
| Rate for Payer: Multiplan All |
$1,796.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,776.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,875.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,480.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,835.82
|
| Rate for Payer: Zelis Auto |
$789.60
|
| Rate for Payer: Zelis Worker's Compensation |
$538.90
|
|
