|
DERM AUTOGRAFT TRNK/ARM/LEG
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 15130
|
| Hospital Charge Code |
6115130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.77 |
| Max. Negotiated Rate |
$1,095.35 |
| Rate for Payer: Cash Price |
$691.80
|
| Rate for Payer: Cigna Commercial |
$980.05
|
| Rate for Payer: First Health Commercial |
$1,037.70
|
| Rate for Payer: First Health Workers Compensation |
$445.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,037.70
|
| Rate for Payer: GEHA Commercial |
$807.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,037.70
|
| Rate for Payer: Multiplan All |
$1,049.23
|
| Rate for Payer: OMNI Networks Commercial |
$807.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,037.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,095.35
|
| Rate for Payer: Three Rivers Provider Network All |
$864.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,072.29
|
| Rate for Payer: Zelis Auto |
$461.20
|
| Rate for Payer: Zelis Worker's Compensation |
$314.77
|
|
|
DERMINATION OF VENOUS PRESSUE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
8193284
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$283.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Humana ChoiceCare |
$92.04
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.40
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$311.52
|
| Rate for Payer: United Healthcare Commercial |
$300.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$177.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
DERMINATION OF VENOUS PRESSUE
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
8193284
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$247.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 23155048901
|
| Hospital Charge Code |
3302975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 23155048901
|
| Hospital Charge Code |
3302975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
DESMOPRESSIN ACETATE 4 MCG/mL
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
3302824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.03 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Worker's Compensation |
$119.03
|
|
|
DESMOPRESSIN ACETATE 4 MCG/mL
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
3302824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.52
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$3.87
|
| Rate for Payer: GEHA Medicare |
$3.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$3.87
|
| Rate for Payer: Humana Medicare Advantage |
$3.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.52
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.98
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.04
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.52
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Medicare |
$2.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.22
|
| Rate for Payer: Zelis Worker's Compensation |
$119.03
|
|
|
DESTROY NERVE FACE MUSCLE
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
6164612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$286.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
DESTROY NERVE FACE MUSCLE
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
6164612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$250.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
DESTROY VAG LESIONS COMPLEX
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 57065
|
| Hospital Charge Code |
6157065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.51 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: First Health Workers Compensation |
$205.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$373.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Worker's Compensation |
$145.51
|
|
|
DESTROY VAG LESIONS COMPLEX
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 57065
|
| Hospital Charge Code |
6157065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.51 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: First Health Workers Compensation |
$205.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$426.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$145.51
|
|
|
DESTROY VULVA LESION/S COMPL
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
6156515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
DESTROY VULVA LESION/S COMPL
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
6156515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
6146924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
6146910
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$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: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$112.75
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
6146910
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
6146924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$396.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
6146900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$114.66 |
| 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 |
$252.00
|
| 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 |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$162.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| 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 |
$382.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| 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 |
$399.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| 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 |
$390.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$114.66
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
6146900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$162.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$294.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.66
|
|
|
DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
8717111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
21600209
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
8300019
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
8300019
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$377.34 |
| 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 |
$231.00
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
6117111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9617111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: First Health Workers Compensation |
$176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$410.40
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$410.40
|
| Rate for Payer: Multiplan All |
$414.96
|
| Rate for Payer: OMNI Networks Commercial |
$319.20
|
| Rate for Payer: One Health Plan PPO/POS |
$410.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$433.20
|
| Rate for Payer: Three Rivers Provider Network All |
$342.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.08
|
| Rate for Payer: Zelis Auto |
$182.40
|
| Rate for Payer: Zelis Worker's Compensation |
$124.49
|
|
