|
PANTOPRAZOLE 40MG EC TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 63739056410
|
| Hospital Charge Code |
3300689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
PANTOPRAZOLE 40MG /NS100ML IVPB
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: First Health Commercial |
$43.20
|
| Rate for Payer: First Health Workers Compensation |
$18.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$43.20
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$43.20
|
| Rate for Payer: Multiplan All |
$43.68
|
| Rate for Payer: OMNI Networks Commercial |
$33.60
|
| Rate for Payer: One Health Plan PPO/POS |
$43.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.60
|
| Rate for Payer: Three Rivers Provider Network All |
$36.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.64
|
| Rate for Payer: Zelis Auto |
$19.20
|
| Rate for Payer: Zelis Worker's Compensation |
$13.10
|
|
|
PANTOPRAZOLE 40MG /NS100ML IVPB
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: First Health Commercial |
$43.20
|
| Rate for Payer: First Health Workers Compensation |
$18.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$43.20
|
| Rate for Payer: GEHA Commercial |
$38.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$43.20
|
| Rate for Payer: Humana ChoiceCare |
$12.48
|
| Rate for Payer: Multiplan All |
$43.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.80
|
| Rate for Payer: OMNI Networks Commercial |
$33.60
|
| Rate for Payer: One Health Plan PPO/POS |
$43.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.60
|
| Rate for Payer: Three Rivers Provider Network All |
$36.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.64
|
| Rate for Payer: Zelis Auto |
$19.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.10
|
|
|
PANTOPRAZOLE SODIUM 40MG IV PUSH
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3370001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: First Health Commercial |
$43.20
|
| Rate for Payer: First Health Workers Compensation |
$18.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$43.20
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$43.20
|
| Rate for Payer: Multiplan All |
$43.68
|
| Rate for Payer: OMNI Networks Commercial |
$33.60
|
| Rate for Payer: One Health Plan PPO/POS |
$43.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.60
|
| Rate for Payer: Three Rivers Provider Network All |
$36.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.64
|
| Rate for Payer: Zelis Auto |
$19.20
|
| Rate for Payer: Zelis Worker's Compensation |
$13.10
|
|
|
PANTOPRAZOLE SODIUM 40MG IV PUSH
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3370001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: First Health Commercial |
$43.20
|
| Rate for Payer: First Health Workers Compensation |
$18.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$43.20
|
| Rate for Payer: GEHA Commercial |
$38.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$43.20
|
| Rate for Payer: Humana ChoiceCare |
$12.48
|
| Rate for Payer: Multiplan All |
$43.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.80
|
| Rate for Payer: OMNI Networks Commercial |
$33.60
|
| Rate for Payer: One Health Plan PPO/POS |
$43.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.60
|
| Rate for Payer: Three Rivers Provider Network All |
$36.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.64
|
| Rate for Payer: Zelis Auto |
$19.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.10
|
|
|
PAP ORAL INTERFACE
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT A7044
|
| Hospital Charge Code |
3000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$61.62
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.20
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$208.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.50
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
PAP ORAL INTERFACE
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT A7044
|
| Hospital Charge Code |
3000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
PAPP A HCG REF
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
2300059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$35.88
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.80
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$121.44
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
PAPP A HCG REF
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
2300059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
papp a REF017200
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
2200102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$26.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$15.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$16.55
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.05
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.59
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.75
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.05
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$12.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.06
|
| Rate for Payer: Zelis Worker's Compensation |
$18.99
|
|
|
papp a REF017200
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
2200102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$26.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.99
|
|
|
parasite examination, wb REF008185
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
2200332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$26.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.75
|
|
|
parasite examination, wb REF008185
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
2200332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$26.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: GEHA Medicare |
$5.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$6.59
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.99
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.18
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.98
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.87
|
| Rate for Payer: United Healthcare Commercial |
$108.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.99
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Medicare |
$5.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.19
|
| Rate for Payer: Zelis Worker's Compensation |
$18.75
|
|
|
parasite identification, worm REF008219
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
2299310
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$49.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
parasite identification, worm REF008219
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
2299310
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.31
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$7.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$56.80
|
| Rate for Payer: GEHA Medicare |
$4.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$4.74
|
| Rate for Payer: Humana Medicare Advantage |
$4.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.31
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.33
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.62
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$60.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.31
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Medicare |
$3.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.17
|
| Rate for Payer: Zelis Worker's Compensation |
$5.31
|
|
|
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED), LAPAROSCOPIC APPROACH
|
Facility
|
OP
|
$19,771.74
|
|
|
Service Code
|
CPT 57423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,603.59 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: First Health Workers Compensation |
$12,723.11
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$8,996.14
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
20300032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| 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 |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
6111056
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$27.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$49.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Worker's Compensation |
$19.38
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
20300032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
1900032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| 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 |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
8300006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9611056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$322.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
1900032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9611056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$368.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| 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 |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
PARING/CUTTING B9 HYPERKERATOTIC LES 2-4
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
8300006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| 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 |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
