|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
25500026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$17.97
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
8517003
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$17.07 |
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna Commercial |
$15.27
|
| Rate for Payer: First Health Commercial |
$16.17
|
| Rate for Payer: First Health Workers Compensation |
$6.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.17
|
| Rate for Payer: GEHA Commercial |
$12.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.17
|
| Rate for Payer: Multiplan All |
$16.35
|
| Rate for Payer: OMNI Networks Commercial |
$12.58
|
| Rate for Payer: One Health Plan PPO/POS |
$16.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.07
|
| Rate for Payer: Three Rivers Provider Network All |
$13.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.71
|
| Rate for Payer: Zelis Auto |
$7.19
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
25500026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
20300027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
6117003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
6117003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
1900027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$59.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$40.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$93.00
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$136.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$77.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.31
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
21600026
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$17.97
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
7217003
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.78
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna Commercial |
$15.27
|
| Rate for Payer: First Health Commercial |
$16.17
|
| Rate for Payer: First Health Workers Compensation |
$127.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.17
|
| Rate for Payer: GEHA Commercial |
$14.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.17
|
| Rate for Payer: Humana ChoiceCare |
$4.67
|
| Rate for Payer: Multiplan All |
$16.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.78
|
| Rate for Payer: OMNI Networks Commercial |
$12.58
|
| Rate for Payer: One Health Plan PPO/POS |
$16.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.07
|
| Rate for Payer: Three Rivers Provider Network All |
$13.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.71
|
| Rate for Payer: Zelis Auto |
$7.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.98
|
| Rate for Payer: Zelis Worker's Compensation |
$89.92
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
1900027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$59.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.31
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$17.97
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
8517003
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna Commercial |
$15.27
|
| Rate for Payer: First Health Commercial |
$16.17
|
| Rate for Payer: First Health Workers Compensation |
$6.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.17
|
| Rate for Payer: GEHA Commercial |
$14.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.17
|
| Rate for Payer: Humana ChoiceCare |
$4.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$16.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.78
|
| Rate for Payer: OMNI Networks Commercial |
$12.58
|
| Rate for Payer: One Health Plan PPO/POS |
$16.17
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.07
|
| Rate for Payer: Three Rivers Provider Network All |
$13.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.71
|
| Rate for Payer: Zelis Auto |
$7.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.98
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$17.97
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
7217003
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna Commercial |
$15.27
|
| Rate for Payer: First Health Commercial |
$16.17
|
| Rate for Payer: First Health Workers Compensation |
$127.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.17
|
| Rate for Payer: GEHA Commercial |
$12.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.17
|
| Rate for Payer: Multiplan All |
$16.35
|
| Rate for Payer: OMNI Networks Commercial |
$12.58
|
| Rate for Payer: One Health Plan PPO/POS |
$16.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.07
|
| Rate for Payer: Three Rivers Provider Network All |
$13.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.71
|
| Rate for Payer: Zelis Auto |
$7.19
|
| Rate for Payer: Zelis Worker's Compensation |
$89.92
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
20300027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
21600026
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$35.53
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.25
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$41.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
DESTRUCTION RECTAL TUMOR
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 45190
|
| Hospital Charge Code |
6145190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$1,361.35 |
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cigna Commercial |
$1,218.05
|
| Rate for Payer: First Health Commercial |
$1,289.70
|
| Rate for Payer: First Health Workers Compensation |
$553.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,289.70
|
| Rate for Payer: GEHA Commercial |
$1,003.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,289.70
|
| Rate for Payer: Multiplan All |
$1,304.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,289.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,361.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,332.69
|
| Rate for Payer: Zelis Auto |
$573.20
|
| Rate for Payer: Zelis Worker's Compensation |
$391.21
|
|
|
DESTRUCTION RECTAL TUMOR
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 45190
|
| Hospital Charge Code |
6145190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cigna Commercial |
$1,218.05
|
| Rate for Payer: First Health Commercial |
$1,289.70
|
| Rate for Payer: First Health Workers Compensation |
$553.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,289.70
|
| Rate for Payer: GEHA Commercial |
$1,146.40
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,289.70
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,304.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,289.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,361.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,332.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$573.20
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$391.21
|
|
|
DESTRUCTION VAGINAL LESIONS SIMPLE
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
21600123
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$6,161.80 |
| 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 |
$177.60
|
| 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 |
$3,080.90
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| 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 |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
DESTRUCTION VAGINAL LESIONS SIMPLE
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
21600123
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
DESTRUCTION VAGINAL LESIONS SIMPLE
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
6157061
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$6,161.80 |
| 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 |
$177.60
|
| 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 |
$3,080.90
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| 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 |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
DESTRUCTION VAGINAL LESIONS SIMPLE
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
6157061
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
DESTRUCT MALIGNANT LESION FEENLM 0.5CM/<
|
Facility
|
OP
|
$387.81
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
7217280
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$385.08 |
| 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 |
$232.69
|
| 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 |
$192.54
|
| Rate for Payer: Cash Price |
$232.69
|
| Rate for Payer: Cash Price |
$232.69
|
| Rate for Payer: Cigna Commercial |
$329.64
|
| Rate for Payer: First Health Commercial |
$349.03
|
| Rate for Payer: First Health Workers Compensation |
$149.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.03
|
| Rate for Payer: GEHA Commercial |
$310.25
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.03
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$352.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$271.47
|
| Rate for Payer: One Health Plan PPO/POS |
$349.03
|
| 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 |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$368.42
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$290.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$360.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$155.12
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$105.87
|
|
|
DESTRUCT MALIGNANT LESION FEENLM 0.5CM/<
|
Facility
|
OP
|
$387.81
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
8517280
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$385.08 |
| 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 |
$232.69
|
| 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 |
$192.54
|
| Rate for Payer: Cash Price |
$232.69
|
| Rate for Payer: Cash Price |
$232.69
|
| Rate for Payer: Cigna Commercial |
$329.64
|
| Rate for Payer: First Health Commercial |
$349.03
|
| Rate for Payer: First Health Workers Compensation |
$149.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.03
|
| Rate for Payer: GEHA Commercial |
$310.25
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.03
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$352.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$271.47
|
| Rate for Payer: One Health Plan PPO/POS |
$349.03
|
| 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 |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$368.42
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$290.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$360.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$155.12
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$105.87
|
|
|
DESTRUCT MALIGNANT LESION FEENLM 0.5CM/<
|
Facility
|
IP
|
$387.81
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
8517280
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$368.42 |
| Rate for Payer: Cash Price |
$232.69
|
| Rate for Payer: Cigna Commercial |
$329.64
|
| Rate for Payer: First Health Commercial |
$349.03
|
| Rate for Payer: First Health Workers Compensation |
$149.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.03
|
| Rate for Payer: GEHA Commercial |
$271.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.03
|
| Rate for Payer: Multiplan All |
$352.91
|
| Rate for Payer: OMNI Networks Commercial |
$271.47
|
| Rate for Payer: One Health Plan PPO/POS |
$349.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$368.42
|
| Rate for Payer: Three Rivers Provider Network All |
$290.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$360.66
|
| Rate for Payer: Zelis Auto |
$155.12
|
| Rate for Payer: Zelis Worker's Compensation |
$105.87
|
|
|
DESTRUCT MALIGNANT LESION FEENLM 0.5CM/<
|
Facility
|
IP
|
$387.81
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
7217280
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$368.42 |
| Rate for Payer: Cash Price |
$232.69
|
| Rate for Payer: Cigna Commercial |
$329.64
|
| Rate for Payer: First Health Commercial |
$349.03
|
| Rate for Payer: First Health Workers Compensation |
$149.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.03
|
| Rate for Payer: GEHA Commercial |
$271.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.03
|
| Rate for Payer: Multiplan All |
$352.91
|
| Rate for Payer: OMNI Networks Commercial |
$271.47
|
| Rate for Payer: One Health Plan PPO/POS |
$349.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$368.42
|
| Rate for Payer: Three Rivers Provider Network All |
$290.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$360.66
|
| Rate for Payer: Zelis Auto |
$155.12
|
| Rate for Payer: Zelis Worker's Compensation |
$105.87
|
|
|
DESTRUCT MALIGNANT LESION FEENLM 0.5CM/<
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
6117280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Worker's Compensation |
$75.35
|
|
