|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
8300011
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$283.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
9400010
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$283.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
7911311
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$283.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
IP
|
$371.76
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
7211311
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$353.17 |
| Rate for Payer: Cash Price |
$223.06
|
| Rate for Payer: Cigna Commercial |
$316.00
|
| Rate for Payer: First Health Commercial |
$334.58
|
| Rate for Payer: First Health Workers Compensation |
$143.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$334.58
|
| Rate for Payer: GEHA Commercial |
$260.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$334.58
|
| Rate for Payer: Multiplan All |
$338.30
|
| Rate for Payer: OMNI Networks Commercial |
$260.23
|
| Rate for Payer: One Health Plan PPO/POS |
$334.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$353.17
|
| Rate for Payer: Three Rivers Provider Network All |
$278.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.74
|
| Rate for Payer: Zelis Auto |
$148.70
|
| Rate for Payer: Zelis Worker's Compensation |
$101.49
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
8300011
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$384.75 |
| 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 |
$243.00
|
| 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 |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$324.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| 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 |
$368.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| 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 |
$384.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| 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 |
$376.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
20300140
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$283.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
IP
|
$371.76
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
8511110
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$353.17 |
| Rate for Payer: Cash Price |
$223.06
|
| Rate for Payer: Cigna Commercial |
$316.00
|
| Rate for Payer: First Health Commercial |
$334.58
|
| Rate for Payer: First Health Workers Compensation |
$143.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$334.58
|
| Rate for Payer: GEHA Commercial |
$260.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$334.58
|
| Rate for Payer: Multiplan All |
$338.30
|
| Rate for Payer: OMNI Networks Commercial |
$260.23
|
| Rate for Payer: One Health Plan PPO/POS |
$334.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$353.17
|
| Rate for Payer: Three Rivers Provider Network All |
$278.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.74
|
| Rate for Payer: Zelis Auto |
$148.70
|
| Rate for Payer: Zelis Worker's Compensation |
$101.49
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 0.6-1.0CM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
7911311
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$384.75 |
| 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 |
$243.00
|
| 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 |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$324.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| 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 |
$368.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| 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 |
$384.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| 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 |
$376.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
20300141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$183.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$332.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$129.68
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
OP
|
$423.42
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
7211312
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$254.05
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$254.05
|
| Rate for Payer: Cash Price |
$254.05
|
| Rate for Payer: Cigna Commercial |
$359.91
|
| Rate for Payer: First Health Commercial |
$381.08
|
| Rate for Payer: First Health Workers Compensation |
$163.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.08
|
| Rate for Payer: GEHA Commercial |
$338.74
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.08
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$385.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$296.39
|
| Rate for Payer: One Health Plan PPO/POS |
$381.08
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$317.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$169.37
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$115.59
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
IP
|
$423.42
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
7211312
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$402.25 |
| Rate for Payer: Cash Price |
$254.05
|
| Rate for Payer: Cigna Commercial |
$359.91
|
| Rate for Payer: First Health Commercial |
$381.08
|
| Rate for Payer: First Health Workers Compensation |
$163.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.08
|
| Rate for Payer: GEHA Commercial |
$296.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.08
|
| Rate for Payer: Multiplan All |
$385.31
|
| Rate for Payer: OMNI Networks Commercial |
$296.39
|
| Rate for Payer: One Health Plan PPO/POS |
$381.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.25
|
| Rate for Payer: Three Rivers Provider Network All |
$317.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.78
|
| Rate for Payer: Zelis Auto |
$169.37
|
| Rate for Payer: Zelis Worker's Compensation |
$115.59
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
6111312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$146.40
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
20300141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$285.00
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$183.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$380.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$129.68
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
OP
|
$423.42
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
8511111
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$254.05
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$254.05
|
| Rate for Payer: Cash Price |
$254.05
|
| Rate for Payer: Cigna Commercial |
$359.91
|
| Rate for Payer: First Health Commercial |
$381.08
|
| Rate for Payer: First Health Workers Compensation |
$163.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.08
|
| Rate for Payer: GEHA Commercial |
$338.74
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.08
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$385.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$296.39
|
| Rate for Payer: One Health Plan PPO/POS |
$381.08
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$317.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$169.37
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$115.59
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
IP
|
$423.42
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
8511111
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$402.25 |
| Rate for Payer: Cash Price |
$254.05
|
| Rate for Payer: Cigna Commercial |
$359.91
|
| Rate for Payer: First Health Commercial |
$381.08
|
| Rate for Payer: First Health Workers Compensation |
$163.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.08
|
| Rate for Payer: GEHA Commercial |
$296.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.08
|
| Rate for Payer: Multiplan All |
$385.31
|
| Rate for Payer: OMNI Networks Commercial |
$296.39
|
| Rate for Payer: One Health Plan PPO/POS |
$381.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.25
|
| Rate for Payer: Three Rivers Provider Network All |
$317.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$393.78
|
| Rate for Payer: Zelis Auto |
$169.37
|
| Rate for Payer: Zelis Worker's Compensation |
$115.59
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
9400011
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$285.00
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$183.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$380.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$129.68
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
6111312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
SHVG SKN LES 1 F/E/E/N/L/M DIA 1.1-2.0CM
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
9400011
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$183.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$332.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$129.68
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$371.07
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
8511103
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$352.52 |
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$315.41
|
| Rate for Payer: First Health Commercial |
$333.96
|
| Rate for Payer: First Health Workers Compensation |
$143.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.96
|
| Rate for Payer: GEHA Commercial |
$259.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.96
|
| Rate for Payer: Multiplan All |
$337.67
|
| Rate for Payer: OMNI Networks Commercial |
$259.75
|
| Rate for Payer: One Health Plan PPO/POS |
$333.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.52
|
| Rate for Payer: Three Rivers Provider Network All |
$278.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.10
|
| Rate for Payer: Zelis Auto |
$148.43
|
| Rate for Payer: Zelis Worker's Compensation |
$101.30
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
9400003
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$161.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$113.84
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
20300133
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$161.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$113.84
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
9400003
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$396.15 |
| 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 |
$250.20
|
| 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 |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$161.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| 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 |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| 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 |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| 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 |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.84
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$371.07
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
7211302
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| 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 |
$222.64
|
| 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 |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$315.41
|
| Rate for Payer: First Health Commercial |
$333.96
|
| Rate for Payer: First Health Workers Compensation |
$143.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.96
|
| Rate for Payer: GEHA Commercial |
$296.86
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.96
|
| 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 |
$337.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$259.75
|
| Rate for Payer: One Health Plan PPO/POS |
$333.96
|
| 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 |
$352.52
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$278.30
|
| 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 |
$345.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$148.43
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.30
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$371.07
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
8511103
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.39 |
| 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 |
$222.64
|
| 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 |
$222.64
|
| Rate for Payer: Cash Price |
$222.64
|
| Rate for Payer: Cigna Commercial |
$315.41
|
| Rate for Payer: First Health Commercial |
$333.96
|
| Rate for Payer: First Health Workers Compensation |
$143.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.96
|
| Rate for Payer: GEHA Commercial |
$296.86
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.96
|
| 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 |
$337.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$259.75
|
| Rate for Payer: One Health Plan PPO/POS |
$333.96
|
| 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 |
$352.52
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$278.30
|
| 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 |
$345.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$148.43
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.30
|
|
|
SHVG SKN LESION 1 T/A/L DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
20300133
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$396.15 |
| 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 |
$250.20
|
| 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 |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$161.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| 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 |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| 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 |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| 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 |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.84
|
|
