|
SKIN PEDICLE FLAP ARMS/LEGS
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 15572
|
| Hospital Charge Code |
6115572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.23 |
| Max. Negotiated Rate |
$1,444.95 |
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cigna Commercial |
$1,292.85
|
| Rate for Payer: First Health Commercial |
$1,368.90
|
| Rate for Payer: First Health Workers Compensation |
$587.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.90
|
| Rate for Payer: GEHA Commercial |
$1,064.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.90
|
| Rate for Payer: Multiplan All |
$1,384.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,414.53
|
| Rate for Payer: Zelis Auto |
$608.40
|
| Rate for Payer: Zelis Worker's Compensation |
$415.23
|
|
|
SKIN PEDICLE FLAP ARMS/LEGS
|
Facility
|
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 15572
|
| Hospital Charge Code |
6115572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.23 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$912.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cigna Commercial |
$1,292.85
|
| Rate for Payer: First Health Commercial |
$1,368.90
|
| Rate for Payer: First Health Workers Compensation |
$587.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.90
|
| Rate for Payer: GEHA Commercial |
$1,216.80
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.90
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,384.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,414.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$608.40
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$415.23
|
|
|
SKIN PEDICLE FLAP TRUNK
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 15570
|
| Hospital Charge Code |
6115570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.87 |
| Max. Negotiated Rate |
$1,429.75 |
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cigna Commercial |
$1,279.25
|
| Rate for Payer: First Health Commercial |
$1,354.50
|
| Rate for Payer: First Health Workers Compensation |
$581.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,354.50
|
| Rate for Payer: GEHA Commercial |
$1,053.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,354.50
|
| Rate for Payer: Multiplan All |
$1,369.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,053.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,354.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,429.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,399.65
|
| Rate for Payer: Zelis Auto |
$602.00
|
| Rate for Payer: Zelis Worker's Compensation |
$410.87
|
|
|
SKIN PEDICLE FLAP TRUNK
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 15570
|
| Hospital Charge Code |
6115570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.87 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$903.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cigna Commercial |
$1,279.25
|
| Rate for Payer: First Health Commercial |
$1,354.50
|
| Rate for Payer: First Health Workers Compensation |
$581.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,354.50
|
| Rate for Payer: GEHA Commercial |
$1,204.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,354.50
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,369.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,053.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,354.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,429.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,399.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$602.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$410.87
|
|
|
SKIN PINCH GRAFT
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 15050
|
| Hospital Charge Code |
6115050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$765.85
|
| Rate for Payer: First Health Commercial |
$810.90
|
| Rate for Payer: First Health Workers Compensation |
$347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.90
|
| Rate for Payer: GEHA Commercial |
$630.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.90
|
| Rate for Payer: Multiplan All |
$819.91
|
| Rate for Payer: OMNI Networks Commercial |
$630.70
|
| Rate for Payer: One Health Plan PPO/POS |
$810.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.95
|
| Rate for Payer: Three Rivers Provider Network All |
$675.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.93
|
| Rate for Payer: Zelis Auto |
$360.40
|
| Rate for Payer: Zelis Worker's Compensation |
$245.97
|
|
|
SKIN PINCH GRAFT
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 15050
|
| Hospital Charge Code |
6115050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$765.85
|
| Rate for Payer: First Health Commercial |
$810.90
|
| Rate for Payer: First Health Workers Compensation |
$347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.90
|
| Rate for Payer: GEHA Commercial |
$720.80
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.90
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$819.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$630.70
|
| Rate for Payer: One Health Plan PPO/POS |
$810.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$675.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$360.40
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$245.97
|
|
|
SKIN PROTECTANTS MISC - CREAM
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
NDC 72140000021
|
| Hospital Charge Code |
3300832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
SKIN PROTECTANTS MISC - CREAM
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
NDC 72140000021
|
| Hospital Charge Code |
3300832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$21.58
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.80
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
SKIN SPLT GRFT T/A/L ADD-ON
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 15101
|
| Hospital Charge Code |
6115101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$2,419.71 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$133.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Humana ChoiceCare |
$90.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.20
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$305.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$173.50
|
| Rate for Payer: Zelis Worker's Compensation |
$94.73
|
|
|
SKIN SPLT GRFT T/A/L ADD-ON
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 15101
|
| Hospital Charge Code |
6115101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$94.73 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$294.95
|
| Rate for Payer: First Health Commercial |
$312.30
|
| Rate for Payer: First Health Workers Compensation |
$133.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.30
|
| Rate for Payer: GEHA Commercial |
$242.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.30
|
| Rate for Payer: Multiplan All |
$315.77
|
| Rate for Payer: OMNI Networks Commercial |
$242.90
|
| Rate for Payer: One Health Plan PPO/POS |
$312.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.65
|
| Rate for Payer: Three Rivers Provider Network All |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.71
|
| Rate for Payer: Zelis Auto |
$138.80
|
| Rate for Payer: Zelis Worker's Compensation |
$94.73
|
|
|
SKIN SPLT GRFT TRNK/ARM/LEG
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
6115100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$880.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,173.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
SKIN SPLT GRFT TRNK/ARM/LEG
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
6115100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| Max. Negotiated Rate |
$1,393.65 |
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,026.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
Skin Sub F/N/HF/G >=100CM 1st 100 LC
|
Facility
|
IP
|
$7,004.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
1905277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,912.09 |
| Max. Negotiated Rate |
$6,653.80 |
| Rate for Payer: Cash Price |
$4,202.40
|
| Rate for Payer: Cigna Commercial |
$5,953.40
|
| Rate for Payer: First Health Commercial |
$6,303.60
|
| Rate for Payer: First Health Workers Compensation |
$2,704.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,303.60
|
| Rate for Payer: GEHA Commercial |
$4,902.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,303.60
|
| Rate for Payer: Multiplan All |
$6,373.64
|
| Rate for Payer: OMNI Networks Commercial |
$4,902.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,303.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,653.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,253.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,513.72
|
| Rate for Payer: Zelis Auto |
$2,801.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,912.09
|
|
|
Skin Sub F/N/HF/G >=100CM 1st 100 LC
|
Facility
|
OP
|
$7,004.00
|
|
|
Service Code
|
CPT C5277
|
| Hospital Charge Code |
1905277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.26 |
| Max. Negotiated Rate |
$6,653.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$569.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,202.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$569.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$451.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$4,202.40
|
| Rate for Payer: Cash Price |
$4,202.40
|
| Rate for Payer: Cigna Commercial |
$5,953.40
|
| Rate for Payer: First Health Commercial |
$6,303.60
|
| Rate for Payer: First Health Workers Compensation |
$2,704.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,303.60
|
| Rate for Payer: GEHA Commercial |
$5,603.20
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,303.60
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$460.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$6,373.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$4,902.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,303.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$531.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$460.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,653.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$5,253.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$460.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,513.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$2,801.60
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$1,912.09
|
|
|
Skin Sub F/N/HF/G <=100CM 1st 25 LC
|
Facility
|
OP
|
$4,323.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
1905275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.26 |
| Max. Negotiated Rate |
$4,106.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$569.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,593.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$569.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$451.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cigna Commercial |
$3,674.55
|
| Rate for Payer: First Health Commercial |
$3,890.70
|
| Rate for Payer: First Health Workers Compensation |
$1,669.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,890.70
|
| Rate for Payer: GEHA Commercial |
$3,458.40
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,890.70
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$460.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$3,933.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$3,026.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,890.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$531.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$460.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,106.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$3,242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$460.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,020.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$1,729.20
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$1,180.18
|
|
|
Skin Sub F/N/HF/G <=100CM 1st 25 LC
|
Facility
|
IP
|
$4,323.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
1905275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,180.18 |
| Max. Negotiated Rate |
$4,106.85 |
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cigna Commercial |
$3,674.55
|
| Rate for Payer: First Health Commercial |
$3,890.70
|
| Rate for Payer: First Health Workers Compensation |
$1,669.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,890.70
|
| Rate for Payer: GEHA Commercial |
$3,026.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,890.70
|
| Rate for Payer: Multiplan All |
$3,933.93
|
| Rate for Payer: OMNI Networks Commercial |
$3,026.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,890.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,106.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,020.39
|
| Rate for Payer: Zelis Auto |
$1,729.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,180.18
|
|
|
Skin Sub F/N/HF/G >=100CM EA 100 LC
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
1905278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$809.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$263.12
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$607.20
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$506.00
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
Skin Sub F/N/HF/G >=100CM EA 100 LC
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C5278
|
| Hospital Charge Code |
1905278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$708.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
Skin Sub F/N/HF/G <=100CM EA 25 LC
|
Facility
|
OP
|
$3,913.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
1905276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.25 |
| Max. Negotiated Rate |
$3,717.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,347.80
|
| Rate for Payer: Cash Price |
$2,347.80
|
| Rate for Payer: Cigna Commercial |
$3,326.05
|
| Rate for Payer: First Health Commercial |
$3,521.70
|
| Rate for Payer: First Health Workers Compensation |
$1,510.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,521.70
|
| Rate for Payer: GEHA Commercial |
$3,130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,521.70
|
| Rate for Payer: Humana ChoiceCare |
$1,017.38
|
| Rate for Payer: Multiplan All |
$3,560.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,347.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,739.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,521.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,717.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,934.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,443.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$978.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,639.09
|
| Rate for Payer: Zelis Auto |
$1,565.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,956.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,068.25
|
|
|
Skin Sub F/N/HF/G <=100CM EA 25 LC
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
CPT C5276
|
| Hospital Charge Code |
1905276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,068.25 |
| Max. Negotiated Rate |
$3,717.35 |
| Rate for Payer: Cash Price |
$2,347.80
|
| Rate for Payer: Cigna Commercial |
$3,326.05
|
| Rate for Payer: First Health Commercial |
$3,521.70
|
| Rate for Payer: First Health Workers Compensation |
$1,510.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,521.70
|
| Rate for Payer: GEHA Commercial |
$2,739.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,521.70
|
| Rate for Payer: Multiplan All |
$3,560.83
|
| Rate for Payer: OMNI Networks Commercial |
$2,739.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,521.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,717.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,934.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,639.09
|
| Rate for Payer: Zelis Auto |
$1,565.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,068.25
|
|
|
Skin Sub T/A/L >=100CM 1st 100CM LC
|
Facility
|
IP
|
$5,756.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
1905273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,571.39 |
| Max. Negotiated Rate |
$5,468.20 |
| Rate for Payer: Cash Price |
$3,453.60
|
| Rate for Payer: Cigna Commercial |
$4,892.60
|
| Rate for Payer: First Health Commercial |
$5,180.40
|
| Rate for Payer: First Health Workers Compensation |
$2,222.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,180.40
|
| Rate for Payer: GEHA Commercial |
$4,029.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,180.40
|
| Rate for Payer: Multiplan All |
$5,237.96
|
| Rate for Payer: OMNI Networks Commercial |
$4,029.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,180.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,468.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,317.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,353.08
|
| Rate for Payer: Zelis Auto |
$2,302.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,571.39
|
|
|
Skin Sub T/A/L >=100CM 1st 100CM LC
|
Facility
|
OP
|
$5,756.00
|
|
|
Service Code
|
CPT C5273
|
| Hospital Charge Code |
1905273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,476.39 |
| Max. Negotiated Rate |
$5,468.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,907.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,453.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,907.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,511.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$3,453.60
|
| Rate for Payer: Cash Price |
$3,453.60
|
| Rate for Payer: Cigna Commercial |
$4,892.60
|
| Rate for Payer: First Health Commercial |
$5,180.40
|
| Rate for Payer: First Health Workers Compensation |
$2,222.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,180.40
|
| Rate for Payer: GEHA Commercial |
$4,604.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,180.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,542.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$5,237.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$4,029.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,180.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,780.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,542.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$4,317.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,542.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,353.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$2,302.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,571.39
|
|
|
Skin Sub T/A/L <=100CM 1st 25CM LC
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
1905271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.98 |
| Max. Negotiated Rate |
$3,097.00 |
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$2,771.00
|
| Rate for Payer: First Health Commercial |
$2,934.00
|
| Rate for Payer: First Health Workers Compensation |
$1,258.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,934.00
|
| Rate for Payer: GEHA Commercial |
$2,282.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,934.00
|
| Rate for Payer: Multiplan All |
$2,966.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,282.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,934.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,097.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,445.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,031.80
|
| Rate for Payer: Zelis Auto |
$1,304.00
|
| Rate for Payer: Zelis Worker's Compensation |
$889.98
|
|
|
Skin Sub T/A/L <=100CM 1st 25CM LC
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
1905271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.26 |
| Max. Negotiated Rate |
$3,097.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$569.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,956.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$569.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$451.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$2,771.00
|
| Rate for Payer: First Health Commercial |
$2,934.00
|
| Rate for Payer: First Health Workers Compensation |
$1,258.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,934.00
|
| Rate for Payer: GEHA Commercial |
$2,608.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,934.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$460.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$2,966.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,282.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,934.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$531.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$460.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,097.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$2,445.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$460.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,031.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$1,304.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$889.98
|
|
|
SKIN SUB T/A/L <=100 CM 1ST 25CM LC
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
20399216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.58 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Cash Price |
$882.60
|
| Rate for Payer: Cigna Commercial |
$1,250.35
|
| Rate for Payer: First Health Commercial |
$1,323.90
|
| Rate for Payer: First Health Workers Compensation |
$567.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.90
|
| Rate for Payer: GEHA Commercial |
$1,029.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.90
|
| Rate for Payer: Multiplan All |
$1,338.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,397.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,103.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.03
|
| Rate for Payer: Zelis Auto |
$588.40
|
| Rate for Payer: Zelis Worker's Compensation |
$401.58
|
|
