|
DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Facility
|
IP
|
$2,107.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
21600502
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$575.21 |
| Max. Negotiated Rate |
$2,001.65 |
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Cigna Commercial |
$1,790.95
|
| Rate for Payer: First Health Commercial |
$1,896.30
|
| Rate for Payer: First Health Workers Compensation |
$813.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,896.30
|
| Rate for Payer: GEHA Commercial |
$1,474.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,896.30
|
| Rate for Payer: Multiplan All |
$1,917.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,474.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,896.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,001.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,580.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,959.51
|
| Rate for Payer: Zelis Auto |
$842.80
|
| Rate for Payer: Zelis Worker's Compensation |
$575.21
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
2410001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$1,449.70 |
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,068.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| Rate for Payer: Multiplan All |
$1,388.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,449.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,419.18
|
| Rate for Payer: Zelis Auto |
$610.40
|
| Rate for Payer: Zelis Worker's Compensation |
$416.60
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
1900002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
2410001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$1,449.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| Rate for Payer: Humana ChoiceCare |
$396.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$1,388.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$915.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,449.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,342.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,419.18
|
| Rate for Payer: Zelis Auto |
$610.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$763.00
|
| Rate for Payer: Zelis Worker's Compensation |
$416.60
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
20300002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$276.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
1000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$1,449.70 |
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,068.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| Rate for Payer: Multiplan All |
$1,388.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,449.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,419.18
|
| Rate for Payer: Zelis Auto |
$610.40
|
| Rate for Payer: Zelis Worker's Compensation |
$416.60
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
6111045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
6111045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$276.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
2766905
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$1,449.70 |
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,068.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| Rate for Payer: Multiplan All |
$1,388.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,449.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,419.18
|
| Rate for Payer: Zelis Auto |
$610.40
|
| Rate for Payer: Zelis Worker's Compensation |
$416.60
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
20300002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
1900002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
DBRDMT SUBCUTANEOUS TISS EA ADD 20 SQ CM
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
2766905
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$1,449.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cigna Commercial |
$1,297.10
|
| Rate for Payer: First Health Commercial |
$1,373.40
|
| Rate for Payer: First Health Workers Compensation |
$589.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,373.40
|
| Rate for Payer: GEHA Commercial |
$1,220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,373.40
|
| Rate for Payer: Humana ChoiceCare |
$396.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$1,388.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$915.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,373.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,449.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,144.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,342.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,419.18
|
| Rate for Payer: Zelis Auto |
$610.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$763.00
|
| Rate for Payer: Zelis Worker's Compensation |
$416.60
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8300004
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,912.35 |
| 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 |
$1,207.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,610.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$2,063.65
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9611042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,960.47 |
| 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 |
$1,238.19
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$1,238.19
|
| Rate for Payer: Cash Price |
$1,238.19
|
| Rate for Payer: Cigna Commercial |
$1,754.10
|
| Rate for Payer: First Health Commercial |
$1,857.29
|
| Rate for Payer: First Health Workers Compensation |
$796.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,857.29
|
| Rate for Payer: GEHA Commercial |
$1,650.92
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,857.29
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,877.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,444.56
|
| Rate for Payer: One Health Plan PPO/POS |
$1,857.29
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,960.47
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,547.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,919.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$825.46
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$563.38
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8711042
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,912.35 |
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,409.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$2,063.65
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9611042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.38 |
| Max. Negotiated Rate |
$1,960.47 |
| Rate for Payer: Cash Price |
$1,238.19
|
| Rate for Payer: Cigna Commercial |
$1,754.10
|
| Rate for Payer: First Health Commercial |
$1,857.29
|
| Rate for Payer: First Health Workers Compensation |
$796.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,857.29
|
| Rate for Payer: GEHA Commercial |
$1,444.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,857.29
|
| Rate for Payer: Multiplan All |
$1,877.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,444.56
|
| Rate for Payer: One Health Plan PPO/POS |
$1,857.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,960.47
|
| Rate for Payer: Three Rivers Provider Network All |
$1,547.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,919.19
|
| Rate for Payer: Zelis Auto |
$825.46
|
| Rate for Payer: Zelis Worker's Compensation |
$563.38
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
23500010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8300004
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,912.35 |
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,409.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$2,013.00
|
|
| Hospital Charge Code |
8111042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,912.35 |
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,409.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8811042
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,912.35 |
| 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 |
$1,207.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,610.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
23500010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$217.20
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$353.34
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8511741
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$335.67 |
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$300.34
|
| Rate for Payer: First Health Commercial |
$318.01
|
| Rate for Payer: First Health Workers Compensation |
$136.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.01
|
| Rate for Payer: GEHA Commercial |
$247.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.01
|
| Rate for Payer: Multiplan All |
$321.54
|
| Rate for Payer: OMNI Networks Commercial |
$247.34
|
| Rate for Payer: One Health Plan PPO/POS |
$318.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.67
|
| Rate for Payer: Three Rivers Provider Network All |
$265.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.61
|
| Rate for Payer: Zelis Auto |
$141.34
|
| Rate for Payer: Zelis Worker's Compensation |
$96.46
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
21600206
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,912.35 |
| 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 |
$1,207.80
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,610.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
6111042
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
DBRDMT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
