|
HEMORRHOIDECTOMY INTERNAL RUBBER BAND LI
|
Facility
|
IP
|
$2,854.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
10046221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.14 |
| Max. Negotiated Rate |
$2,711.30 |
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Cigna Commercial |
$2,425.90
|
| Rate for Payer: First Health Commercial |
$2,568.60
|
| Rate for Payer: First Health Workers Compensation |
$1,101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,568.60
|
| Rate for Payer: GEHA Commercial |
$1,997.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,568.60
|
| Rate for Payer: Multiplan All |
$2,597.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,997.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,568.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,711.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,140.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,654.22
|
| Rate for Payer: Zelis Auto |
$1,141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$779.14
|
|
|
HEMORRHOIDECTOMY INTERNAL RUBBER BAND LI
|
Facility
|
IP
|
$2,854.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
20346221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$779.14 |
| Max. Negotiated Rate |
$2,711.30 |
| Rate for Payer: Cash Price |
$1,712.40
|
| Rate for Payer: Cigna Commercial |
$2,425.90
|
| Rate for Payer: First Health Commercial |
$2,568.60
|
| Rate for Payer: First Health Workers Compensation |
$1,101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,568.60
|
| Rate for Payer: GEHA Commercial |
$1,997.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,568.60
|
| Rate for Payer: Multiplan All |
$2,597.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,997.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,568.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,711.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,140.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,654.22
|
| Rate for Payer: Zelis Auto |
$1,141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$779.14
|
|
|
HEMORRHOIDECTOMY INTERNAL RUBBER BAND LI
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
6146221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$406.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: Zelis Auto |
$232.00
|
| Rate for Payer: Zelis Worker's Compensation |
$158.34
|
|
|
HEMORRHOIDECTOMY NTRNL&XTRNL 1 COLMN/GRP
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
20300073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$1,486.75 |
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,330.25
|
| Rate for Payer: First Health Commercial |
$1,408.50
|
| Rate for Payer: First Health Workers Compensation |
$604.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,408.50
|
| Rate for Payer: GEHA Commercial |
$1,095.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,408.50
|
| Rate for Payer: Multiplan All |
$1,424.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,095.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,408.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,486.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,455.45
|
| Rate for Payer: Zelis Auto |
$626.00
|
| Rate for Payer: Zelis Worker's Compensation |
$427.25
|
|
|
HEMORRHOIDECTOMY NTRNL&XTRNL 1 COLMN/GRP
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
6146255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
HEMORRHOIDECTOMY NTRNL&XTRNL 1 COLMN/GRP
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
6146255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$669.00
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| 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 |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$446.00
|
| 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 |
$304.39
|
|
|
HEMORRHOIDECTOMY NTRNL&XTRNL 1 COLMN/GRP
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
20300073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$939.00
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,330.25
|
| Rate for Payer: First Health Commercial |
$1,408.50
|
| Rate for Payer: First Health Workers Compensation |
$604.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,408.50
|
| Rate for Payer: GEHA Commercial |
$1,252.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,408.50
|
| 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 |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,424.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,095.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,408.50
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,486.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,455.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$626.00
|
| 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 |
$427.25
|
|
|
HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
20300072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$388.75 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$854.40
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$1,210.40
|
| Rate for Payer: First Health Commercial |
$1,281.60
|
| Rate for Payer: First Health Workers Compensation |
$549.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,281.60
|
| Rate for Payer: GEHA Commercial |
$1,139.20
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,281.60
|
| 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 |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,295.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$996.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,281.60
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,352.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,324.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$569.60
|
| 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 |
$388.75
|
|
|
HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Facility
|
OP
|
$1,385.16
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
6146250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$378.15 |
| Max. Negotiated Rate |
$5,208.02 |
| 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 |
$831.10
|
| 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 |
$2,604.01
|
| Rate for Payer: Cash Price |
$831.10
|
| Rate for Payer: Cash Price |
$831.10
|
| Rate for Payer: Cigna Commercial |
$1,177.39
|
| Rate for Payer: First Health Commercial |
$1,246.64
|
| Rate for Payer: First Health Workers Compensation |
$534.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,246.64
|
| Rate for Payer: GEHA Commercial |
$1,108.13
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,246.64
|
| 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 |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,260.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$969.61
|
| Rate for Payer: One Health Plan PPO/POS |
$1,246.64
|
| 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 |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,315.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.87
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$554.06
|
| 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 |
$378.15
|
|
|
HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Facility
|
IP
|
$1,385.16
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
6146250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$378.15 |
| Max. Negotiated Rate |
$1,315.90 |
| Rate for Payer: Cash Price |
$831.10
|
| Rate for Payer: Cigna Commercial |
$1,177.39
|
| Rate for Payer: First Health Commercial |
$1,246.64
|
| Rate for Payer: First Health Workers Compensation |
$534.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,246.64
|
| Rate for Payer: GEHA Commercial |
$969.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,246.64
|
| Rate for Payer: Multiplan All |
$1,260.50
|
| Rate for Payer: OMNI Networks Commercial |
$969.61
|
| Rate for Payer: One Health Plan PPO/POS |
$1,246.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,315.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.20
|
| Rate for Payer: Zelis Auto |
$554.06
|
| Rate for Payer: Zelis Worker's Compensation |
$378.15
|
|
|
HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
20300072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$388.75 |
| Max. Negotiated Rate |
$1,352.80 |
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$1,210.40
|
| Rate for Payer: First Health Commercial |
$1,281.60
|
| Rate for Payer: First Health Workers Compensation |
$549.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,281.60
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,281.60
|
| Rate for Payer: Multiplan All |
$1,295.84
|
| Rate for Payer: OMNI Networks Commercial |
$996.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,281.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,352.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,324.32
|
| Rate for Payer: Zelis Auto |
$569.60
|
| Rate for Payer: Zelis Worker's Compensation |
$388.75
|
|
|
HEMORRHOIDOPEXY BY STAPLING
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 46947
|
| Hospital Charge Code |
6146947
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
HEMORRHOIDOPEXY BY STAPLING
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 46947
|
| Hospital Charge Code |
6146947
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| 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 |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$396.00
|
| 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 |
$270.27
|
|
|
HEPARIN 25000 UNITS/500ML PREMIX
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
3300401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: First Health Workers Compensation |
$12.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$0.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Humana ChoiceCare |
$8.58
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.80
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.50
|
| Rate for Payer: Zelis Worker's Compensation |
$9.01
|
|
|
HEPARIN 25000 UNITS/500ML PREMIX
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
3300401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: First Health Workers Compensation |
$12.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$23.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Worker's Compensation |
$9.01
|
|
|
heparin anti-Xa REF117101
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
2299552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$23.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.31
|
|
|
heparin anti-Xa REF117101
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
2299552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$23.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$13.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$14.40
|
| Rate for Payer: Humana Medicare Advantage |
$13.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.09
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.25
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$26.18
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.83
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.09
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$11.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.71
|
| Rate for Payer: Zelis Worker's Compensation |
$16.31
|
|
|
HEPARIN INJ 5000 UNITS/ML
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
3300402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$37.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
HEPARIN INJ 5000 UNITS/ML
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
3300402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$0.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Humana ChoiceCare |
$13.78
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.80
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.50
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
HEPARIN LOCK FLUSH 100 UNIT/ML
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
3300403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$0.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
HEPARIN LOCK FLUSH 100 UNIT/ML
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
3300403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
HEPARIN LOCKFLUSH 500U/5ML
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
3302807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
HEPARIN LOCKFLUSH 500U/5ML
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
3302807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$0.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
HEPARIN LOCK FLUSH 50 UN/ 5 ML
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
3302843
|
|
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
|
|
|
HEPARIN LOCK FLUSH 50 UN/ 5 ML
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
3302843
|
|
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
|
|
