|
REMOVE SPINE INFUSION DEVICE
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 62365
|
| Hospital Charge Code |
6162365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.66 |
| Max. Negotiated Rate |
$12,410.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,419.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$460.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,419.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,501.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,205.42
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$652.80
|
| Rate for Payer: First Health Commercial |
$691.20
|
| Rate for Payer: First Health Workers Compensation |
$296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$691.20
|
| Rate for Payer: GEHA Commercial |
$614.40
|
| Rate for Payer: GEHA Medicare |
$6,205.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$691.20
|
| Rate for Payer: Humana ChoiceCare |
$6,825.96
|
| Rate for Payer: Humana Medicare Advantage |
$6,205.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,425.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,572.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,205.42
|
| Rate for Payer: Multiplan All |
$698.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,549.21
|
| Rate for Payer: OMNI Networks Commercial |
$537.60
|
| Rate for Payer: One Health Plan PPO/POS |
$691.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,124.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,572.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,205.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$729.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,410.84
|
| Rate for Payer: Three Rivers Provider Network All |
$576.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,081.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,572.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,205.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$714.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,205.42
|
| Rate for Payer: Zelis Auto |
$307.20
|
| Rate for Payer: Zelis Medicare |
$5,274.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,446.50
|
| Rate for Payer: Zelis Worker's Compensation |
$209.66
|
|
|
REMOVE SPINE INFUSION DEVICE
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 62365
|
| Hospital Charge Code |
6162365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.66 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$652.80
|
| Rate for Payer: First Health Commercial |
$691.20
|
| Rate for Payer: First Health Workers Compensation |
$296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$691.20
|
| Rate for Payer: GEHA Commercial |
$537.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$691.20
|
| Rate for Payer: Multiplan All |
$698.88
|
| Rate for Payer: OMNI Networks Commercial |
$537.60
|
| Rate for Payer: One Health Plan PPO/POS |
$691.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$729.60
|
| Rate for Payer: Three Rivers Provider Network All |
$576.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$714.24
|
| Rate for Payer: Zelis Auto |
$307.20
|
| Rate for Payer: Zelis Worker's Compensation |
$209.66
|
|
|
REMOVE SPINE LAMINA >2 THRC
|
Facility
|
OP
|
$3,228.00
|
|
|
Service Code
|
CPT 63016
|
| Hospital Charge Code |
6163016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$881.24 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,977.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,936.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,977.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,942.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cigna Commercial |
$2,743.80
|
| Rate for Payer: First Health Commercial |
$2,905.20
|
| Rate for Payer: First Health Workers Compensation |
$1,246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,905.20
|
| Rate for Payer: GEHA Commercial |
$2,582.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,905.20
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,023.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$2,937.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$2,259.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,905.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,645.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,023.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,066.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,421.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,023.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,002.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$1,291.20
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$881.24
|
|
|
REMOVE SPINE LAMINA >2 THRC
|
Facility
|
IP
|
$3,228.00
|
|
|
Service Code
|
CPT 63016
|
| Hospital Charge Code |
6163016
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$881.24 |
| Max. Negotiated Rate |
$3,066.60 |
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cigna Commercial |
$2,743.80
|
| Rate for Payer: First Health Commercial |
$2,905.20
|
| Rate for Payer: First Health Workers Compensation |
$1,246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,905.20
|
| Rate for Payer: GEHA Commercial |
$2,259.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,905.20
|
| Rate for Payer: Multiplan All |
$2,937.48
|
| Rate for Payer: OMNI Networks Commercial |
$2,259.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,905.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,066.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,421.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,002.04
|
| Rate for Payer: Zelis Auto |
$1,291.20
|
| Rate for Payer: Zelis Worker's Compensation |
$881.24
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 64822
|
| Hospital Charge Code |
6164822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 64822
|
| Hospital Charge Code |
6164822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
CPT 64818
|
| Hospital Charge Code |
6164818
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$1,214.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$766.80
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$1,086.30
|
| Rate for Payer: First Health Commercial |
$1,150.20
|
| Rate for Payer: First Health Workers Compensation |
$493.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,150.20
|
| Rate for Payer: GEHA Commercial |
$1,022.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,150.20
|
| Rate for Payer: Humana ChoiceCare |
$332.28
|
| Rate for Payer: Multiplan All |
$1,162.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$766.80
|
| Rate for Payer: OMNI Networks Commercial |
$894.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,150.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,214.10
|
| Rate for Payer: Three Rivers Provider Network All |
$958.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,124.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,188.54
|
| Rate for Payer: Zelis Auto |
$511.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$639.00
|
| Rate for Payer: Zelis Worker's Compensation |
$348.89
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
OP
|
$2,148.00
|
|
|
Service Code
|
CPT 64809
|
| Hospital Charge Code |
6164809
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Humana ChoiceCare |
$558.48
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,288.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,890.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$537.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,074.00
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
IP
|
$2,148.00
|
|
|
Service Code
|
CPT 64809
|
| Hospital Charge Code |
6164809
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.40 |
| Max. Negotiated Rate |
$2,040.60 |
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$1,825.80
|
| Rate for Payer: First Health Commercial |
$1,933.20
|
| Rate for Payer: First Health Workers Compensation |
$829.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,933.20
|
| Rate for Payer: GEHA Commercial |
$1,503.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,933.20
|
| Rate for Payer: Multiplan All |
$1,954.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,503.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,933.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,040.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,997.64
|
| Rate for Payer: Zelis Auto |
$859.20
|
| Rate for Payer: Zelis Worker's Compensation |
$586.40
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
CPT 64804
|
| Hospital Charge Code |
6164804
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.39 |
| Max. Negotiated Rate |
$3,784.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,269.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,892.20
|
| Rate for Payer: Cash Price |
$1,269.00
|
| Rate for Payer: Cash Price |
$1,269.00
|
| Rate for Payer: Cigna Commercial |
$1,797.75
|
| Rate for Payer: First Health Commercial |
$1,903.50
|
| Rate for Payer: First Health Workers Compensation |
$816.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,903.50
|
| Rate for Payer: GEHA Commercial |
$1,692.00
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,903.50
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$1,924.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,480.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,903.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,009.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,586.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,966.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$846.00
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$577.39
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
CPT 64804
|
| Hospital Charge Code |
6164804
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.39 |
| Max. Negotiated Rate |
$2,009.25 |
| Rate for Payer: Cash Price |
$1,269.00
|
| Rate for Payer: Cigna Commercial |
$1,797.75
|
| Rate for Payer: First Health Commercial |
$1,903.50
|
| Rate for Payer: First Health Workers Compensation |
$816.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,903.50
|
| Rate for Payer: GEHA Commercial |
$1,480.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,903.50
|
| Rate for Payer: Multiplan All |
$1,924.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,480.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,903.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,009.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,586.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,966.95
|
| Rate for Payer: Zelis Auto |
$846.00
|
| Rate for Payer: Zelis Worker's Compensation |
$577.39
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 64821
|
| Hospital Charge Code |
6164821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
CPT 64818
|
| Hospital Charge Code |
6164818
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.89 |
| Max. Negotiated Rate |
$1,214.10 |
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$1,086.30
|
| Rate for Payer: First Health Commercial |
$1,150.20
|
| Rate for Payer: First Health Workers Compensation |
$493.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,150.20
|
| Rate for Payer: GEHA Commercial |
$894.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,150.20
|
| Rate for Payer: Multiplan All |
$1,162.98
|
| Rate for Payer: OMNI Networks Commercial |
$894.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,150.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,214.10
|
| Rate for Payer: Three Rivers Provider Network All |
$958.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,188.54
|
| Rate for Payer: Zelis Auto |
$511.20
|
| Rate for Payer: Zelis Worker's Compensation |
$348.89
|
|
|
REMOVE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 64821
|
| Hospital Charge Code |
6164821
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 15953
|
| Hospital Charge Code |
6115953
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$552.55 |
| Max. Negotiated Rate |
$7,094.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,214.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,547.41
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$1,720.40
|
| Rate for Payer: First Health Commercial |
$1,821.60
|
| Rate for Payer: First Health Workers Compensation |
$781.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,821.60
|
| Rate for Payer: GEHA Commercial |
$1,619.20
|
| Rate for Payer: GEHA Medicare |
$3,547.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,821.60
|
| Rate for Payer: Humana ChoiceCare |
$3,902.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,547.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,959.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,547.41
|
| Rate for Payer: Multiplan All |
$1,841.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,030.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,416.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,821.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,547.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,922.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,094.82
|
| Rate for Payer: Three Rivers Provider Network All |
$1,518.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,476.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,547.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,882.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,547.41
|
| Rate for Payer: Zelis Auto |
$809.60
|
| Rate for Payer: Zelis Medicare |
$3,015.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,256.89
|
| Rate for Payer: Zelis Worker's Compensation |
$552.55
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 15950
|
| Hospital Charge Code |
6115950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cigna Commercial |
$1,029.35
|
| Rate for Payer: First Health Commercial |
$1,089.90
|
| Rate for Payer: First Health Workers Compensation |
$467.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.90
|
| Rate for Payer: GEHA Commercial |
$847.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.90
|
| Rate for Payer: Multiplan All |
$1,102.01
|
| Rate for Payer: OMNI Networks Commercial |
$847.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,150.45
|
| Rate for Payer: Three Rivers Provider Network All |
$908.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,126.23
|
| Rate for Payer: Zelis Auto |
$484.40
|
| Rate for Payer: Zelis Worker's Compensation |
$330.60
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 15952
|
| Hospital Charge Code |
6115952
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$498.23 |
| Max. Negotiated Rate |
$1,733.75 |
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,551.25
|
| Rate for Payer: First Health Commercial |
$1,642.50
|
| Rate for Payer: First Health Workers Compensation |
$704.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,642.50
|
| Rate for Payer: GEHA Commercial |
$1,277.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,642.50
|
| Rate for Payer: Multiplan All |
$1,660.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,277.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,642.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,733.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,368.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,697.25
|
| Rate for Payer: Zelis Auto |
$730.00
|
| Rate for Payer: Zelis Worker's Compensation |
$498.23
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 15952
|
| Hospital Charge Code |
6115952
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$498.23 |
| Max. Negotiated Rate |
$3,544.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,772.49
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,551.25
|
| Rate for Payer: First Health Commercial |
$1,642.50
|
| Rate for Payer: First Health Workers Compensation |
$704.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,642.50
|
| Rate for Payer: GEHA Commercial |
$1,460.00
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,642.50
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$1,660.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,277.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,642.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,733.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$1,368.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,697.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$730.00
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$498.23
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 15950
|
| Hospital Charge Code |
6115950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cigna Commercial |
$1,029.35
|
| Rate for Payer: First Health Commercial |
$1,089.90
|
| Rate for Payer: First Health Workers Compensation |
$467.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.90
|
| Rate for Payer: GEHA Commercial |
$968.80
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.90
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$1,102.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$847.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,150.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$908.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,126.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$484.40
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$330.60
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
IP
|
$1,783.00
|
|
|
Service Code
|
CPT 15951
|
| Hospital Charge Code |
6115951
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$1,693.85 |
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$1,515.55
|
| Rate for Payer: First Health Commercial |
$1,604.70
|
| Rate for Payer: First Health Workers Compensation |
$688.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,604.70
|
| Rate for Payer: GEHA Commercial |
$1,248.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,604.70
|
| Rate for Payer: Multiplan All |
$1,622.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,248.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,604.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,693.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,337.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,658.19
|
| Rate for Payer: Zelis Auto |
$713.20
|
| Rate for Payer: Zelis Worker's Compensation |
$486.76
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
OP
|
$2,401.00
|
|
|
Service Code
|
CPT 15958
|
| Hospital Charge Code |
6115958
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$655.47 |
| Max. Negotiated Rate |
$7,094.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,440.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,547.41
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$2,040.85
|
| Rate for Payer: First Health Commercial |
$2,160.90
|
| Rate for Payer: First Health Workers Compensation |
$927.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,160.90
|
| Rate for Payer: GEHA Commercial |
$1,920.80
|
| Rate for Payer: GEHA Medicare |
$3,547.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,160.90
|
| Rate for Payer: Humana ChoiceCare |
$3,902.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,547.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,959.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,547.41
|
| Rate for Payer: Multiplan All |
$2,184.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,030.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,680.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,160.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,547.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,280.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,094.82
|
| Rate for Payer: Three Rivers Provider Network All |
$1,800.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,476.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,547.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,232.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,547.41
|
| Rate for Payer: Zelis Auto |
$960.40
|
| Rate for Payer: Zelis Medicare |
$3,015.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,256.89
|
| Rate for Payer: Zelis Worker's Compensation |
$655.47
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
IP
|
$2,401.00
|
|
|
Service Code
|
CPT 15958
|
| Hospital Charge Code |
6115958
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$655.47 |
| Max. Negotiated Rate |
$2,280.95 |
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$2,040.85
|
| Rate for Payer: First Health Commercial |
$2,160.90
|
| Rate for Payer: First Health Workers Compensation |
$927.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,160.90
|
| Rate for Payer: GEHA Commercial |
$1,680.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,160.90
|
| Rate for Payer: Multiplan All |
$2,184.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,680.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,160.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,280.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,800.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,232.93
|
| Rate for Payer: Zelis Auto |
$960.40
|
| Rate for Payer: Zelis Worker's Compensation |
$655.47
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
OP
|
$1,783.00
|
|
|
Service Code
|
CPT 15951
|
| Hospital Charge Code |
6115951
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,069.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$1,515.55
|
| Rate for Payer: First Health Commercial |
$1,604.70
|
| Rate for Payer: First Health Workers Compensation |
$688.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,604.70
|
| Rate for Payer: GEHA Commercial |
$1,426.40
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,604.70
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,622.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,248.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,604.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,693.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,337.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,658.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$713.20
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$486.76
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
OP
|
$2,366.00
|
|
|
Service Code
|
CPT 15956
|
| Hospital Charge Code |
6115956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$645.92 |
| Max. Negotiated Rate |
$3,544.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,419.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,772.49
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$2,011.10
|
| Rate for Payer: First Health Commercial |
$2,129.40
|
| Rate for Payer: First Health Workers Compensation |
$913.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,129.40
|
| Rate for Payer: GEHA Commercial |
$1,892.80
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,129.40
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$2,153.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,656.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,129.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,247.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$1,774.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,200.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$946.40
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$645.92
|
|
|
REMOVE THIGH PRESSURE SORE
|
Facility
|
IP
|
$2,366.00
|
|
|
Service Code
|
CPT 15956
|
| Hospital Charge Code |
6115956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$645.92 |
| Max. Negotiated Rate |
$2,247.70 |
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$2,011.10
|
| Rate for Payer: First Health Commercial |
$2,129.40
|
| Rate for Payer: First Health Workers Compensation |
$913.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,129.40
|
| Rate for Payer: GEHA Commercial |
$1,656.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,129.40
|
| Rate for Payer: Multiplan All |
$2,153.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,656.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,129.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,247.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,774.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,200.38
|
| Rate for Payer: Zelis Auto |
$946.40
|
| Rate for Payer: Zelis Worker's Compensation |
$645.92
|
|
