|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$1,974.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
1900004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.90 |
| Max. Negotiated Rate |
$1,875.30 |
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna Commercial |
$1,677.90
|
| Rate for Payer: First Health Commercial |
$1,776.60
|
| Rate for Payer: First Health Workers Compensation |
$762.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,776.60
|
| Rate for Payer: GEHA Commercial |
$1,381.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,776.60
|
| Rate for Payer: Multiplan All |
$1,796.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,776.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,875.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,480.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,835.82
|
| Rate for Payer: Zelis Auto |
$789.60
|
| Rate for Payer: Zelis Worker's Compensation |
$538.90
|
|
|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
20300004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$276.21 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$87.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$58.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.60
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.00
|
| Rate for Payer: Zelis Worker's Compensation |
$61.70
|
|
|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$1,974.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
1900004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$1,875.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,184.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna Commercial |
$1,677.90
|
| Rate for Payer: First Health Commercial |
$1,776.60
|
| Rate for Payer: First Health Workers Compensation |
$762.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,776.60
|
| Rate for Payer: GEHA Commercial |
$1,579.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,776.60
|
| Rate for Payer: Humana ChoiceCare |
$513.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$1,796.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,184.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,381.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,776.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,875.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,480.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,835.82
|
| Rate for Payer: Zelis Auto |
$789.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$987.00
|
| Rate for Payer: Zelis Worker's Compensation |
$538.90
|
|
|
DBRDMNT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
6111046
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
IP
|
$3,483.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
8111000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$950.86 |
| Max. Negotiated Rate |
$3,308.85 |
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna Commercial |
$2,960.55
|
| Rate for Payer: First Health Commercial |
$3,134.70
|
| Rate for Payer: First Health Workers Compensation |
$1,344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,134.70
|
| Rate for Payer: GEHA Commercial |
$2,438.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,134.70
|
| Rate for Payer: Multiplan All |
$3,169.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,438.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,134.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,308.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,612.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,239.19
|
| Rate for Payer: Zelis Auto |
$1,393.20
|
| Rate for Payer: Zelis Worker's Compensation |
$950.86
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
20300048
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
21600208
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
OP
|
$2,235.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
1911000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,341.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: First Health Workers Compensation |
$862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,788.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$610.15
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
6111000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
6111000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
IP
|
$2,235.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
1911000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.15 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: First Health Workers Compensation |
$862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,564.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Worker's Compensation |
$610.15
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
20300048
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$132.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
OP
|
$3,483.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
8111000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$3,308.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,089.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cash Price |
$2,089.80
|
| Rate for Payer: Cigna Commercial |
$2,960.55
|
| Rate for Payer: First Health Commercial |
$3,134.70
|
| Rate for Payer: First Health Workers Compensation |
$1,344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,134.70
|
| Rate for Payer: GEHA Commercial |
$2,786.40
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,134.70
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$3,169.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,438.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,134.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,308.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$2,612.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,239.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$1,393.20
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$950.86
|
|
|
DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10%
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
21600208
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
20300049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$88.86 |
| 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 |
$39.60
|
| 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: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.60
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
6111001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$32.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
1911001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$1,062.10 |
| 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 |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cigna Commercial |
$950.30
|
| Rate for Payer: First Health Commercial |
$1,006.20
|
| Rate for Payer: First Health Workers Compensation |
$431.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,006.20
|
| Rate for Payer: GEHA Commercial |
$894.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,006.20
|
| Rate for Payer: Humana ChoiceCare |
$290.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$1,017.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$670.80
|
| Rate for Payer: OMNI Networks Commercial |
$782.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,006.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,062.10
|
| Rate for Payer: Three Rivers Provider Network All |
$838.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$983.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,039.74
|
| Rate for Payer: Zelis Auto |
$447.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.00
|
| Rate for Payer: Zelis Worker's Compensation |
$305.21
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
20300049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
1911001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.21 |
| Max. Negotiated Rate |
$1,062.10 |
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cigna Commercial |
$950.30
|
| Rate for Payer: First Health Commercial |
$1,006.20
|
| Rate for Payer: First Health Workers Compensation |
$431.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,006.20
|
| Rate for Payer: GEHA Commercial |
$782.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,006.20
|
| Rate for Payer: Multiplan All |
$1,017.38
|
| Rate for Payer: OMNI Networks Commercial |
$782.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,006.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,062.10
|
| Rate for Payer: Three Rivers Provider Network All |
$838.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,039.74
|
| Rate for Payer: Zelis Auto |
$447.20
|
| Rate for Payer: Zelis Worker's Compensation |
$305.21
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
OP
|
$1,010.00
|
|
| Hospital Charge Code |
8111001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$959.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$808.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Humana ChoiceCare |
$262.60
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$606.00
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$888.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$252.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$505.00
|
| Rate for Payer: Zelis Worker's Compensation |
$275.73
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
IP
|
$1,010.00
|
|
| Hospital Charge Code |
8111001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.73 |
| Max. Negotiated Rate |
$959.50 |
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$707.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Worker's Compensation |
$275.73
|
|
|
DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10%
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
6111001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.86 |
| 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 |
$27.60
|
| 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: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$36.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$11.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.60
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
6111012
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.42 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$710.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
6111012
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.42 |
| Max. Negotiated Rate |
$843.60 |
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Facility
|
OP
|
$2,107.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
21600502
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$349.43 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,264.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Cash Price |
$1,264.20
|
| Rate for Payer: Cigna Commercial |
$1,790.95
|
| Rate for Payer: First Health Commercial |
$1,896.30
|
| Rate for Payer: First Health Workers Compensation |
$813.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,896.30
|
| Rate for Payer: GEHA Commercial |
$1,685.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,896.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,917.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,474.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,896.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,001.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,580.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,959.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$842.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$575.21
|
|
