|
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 |
$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 |
$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 |
$188.67
|
| 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 |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.03
|
| 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 |
$352.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| 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 |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$368.42
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$290.86
|
| 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 |
$360.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$155.12
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$105.87
|
|
|
DESTRUCT MALIGNANT LESION T/A/L 0.5CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
9400032
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.71 |
| 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 |
$168.60
|
| 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 |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$224.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| 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 |
$255.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| 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 |
$266.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| 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 |
$261.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DESTRUCT MALIGNANT LESION T/A/L 0.5CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
6117260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$196.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DESTRUCT MALIGNANT LESION T/A/L 0.5CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
6117260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| 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 |
$168.60
|
| 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 |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$224.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| 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 |
$255.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| 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 |
$266.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| 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 |
$261.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DESTRUCT MALIGNANT LESION T/A/L 0.5CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
9400032
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$196.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DEVEL TST PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
9599216
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$313.60
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$164.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$164.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
DEVEL TST PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
4397908
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$313.60
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$164.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$164.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Commercial |
$333.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
DEVEL TST PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
4397908
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
DEVEL TST PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
9599216
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
DEVEL TST PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
8499216
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
DEVEL TST PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
8499216
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$333.20
|
| Rate for Payer: First Health Commercial |
$352.80
|
| Rate for Payer: First Health Workers Compensation |
$151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$352.80
|
| Rate for Payer: GEHA Commercial |
$313.60
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$352.80
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$164.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$356.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$274.40
|
| Rate for Payer: One Health Plan PPO/POS |
$352.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$372.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$294.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$364.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$156.80
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$107.02
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
9599217
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
4397909
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
8499217
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$46.80
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.00
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
8499217
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
4397909
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$46.80
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.00
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
9599217
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$46.80
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.00
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$158.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
DEVISE BOWEL POUCH
|
Facility
|
IP
|
$2,986.00
|
|
|
Service Code
|
CPT 44316
|
| Hospital Charge Code |
6144316
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$815.18 |
| Max. Negotiated Rate |
$2,836.70 |
| Rate for Payer: Cash Price |
$1,791.60
|
| Rate for Payer: Cigna Commercial |
$2,538.10
|
| Rate for Payer: First Health Commercial |
$2,687.40
|
| Rate for Payer: First Health Workers Compensation |
$1,152.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,687.40
|
| Rate for Payer: GEHA Commercial |
$2,090.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,687.40
|
| Rate for Payer: Multiplan All |
$2,717.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,090.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,687.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,836.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,239.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,776.98
|
| Rate for Payer: Zelis Auto |
$1,194.40
|
| Rate for Payer: Zelis Worker's Compensation |
$815.18
|
|
|
DEVISE BOWEL POUCH
|
Facility
|
OP
|
$2,986.00
|
|
|
Service Code
|
CPT 44316
|
| Hospital Charge Code |
6144316
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$746.50 |
| Max. Negotiated Rate |
$2,836.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,791.60
|
| Rate for Payer: Cash Price |
$1,791.60
|
| Rate for Payer: Cigna Commercial |
$2,538.10
|
| Rate for Payer: First Health Commercial |
$2,687.40
|
| Rate for Payer: First Health Workers Compensation |
$1,152.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,687.40
|
| Rate for Payer: GEHA Commercial |
$2,388.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,687.40
|
| Rate for Payer: Humana ChoiceCare |
$776.36
|
| Rate for Payer: Multiplan All |
$2,717.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,791.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,090.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,687.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,836.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,239.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,627.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$746.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,776.98
|
| Rate for Payer: Zelis Auto |
$1,194.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,493.00
|
| Rate for Payer: Zelis Worker's Compensation |
$815.18
|
|
|
DEXAMETHASONE 0.25 MG/2.5 ML ORAL SOLN
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
3303083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
DEXAMETHASONE 0.25 MG/2.5 ML ORAL SOLN
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
3303083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$0.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
DEXAMETHASONE 10 MG/ML PF, INJ
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
3302812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
DEXAMETHASONE 10 MG/ML PF, INJ
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
3302812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$0.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
DEXAMETHASONE 10 MG/ML W/PRES INJ
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
3303021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$0.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
DEXAMETHASONE 10 MG/ML W/PRES INJ
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
3303021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
