|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
OP
|
$1,226.49
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
8511040
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$334.83 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$735.89
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$735.89
|
| Rate for Payer: Cash Price |
$735.89
|
| Rate for Payer: Cigna Commercial |
$1,042.52
|
| Rate for Payer: First Health Commercial |
$1,103.84
|
| Rate for Payer: First Health Workers Compensation |
$473.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.84
|
| Rate for Payer: GEHA Commercial |
$981.19
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.84
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,116.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$858.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.84
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,165.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$919.87
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$490.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$334.83
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
21600291
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$238.06 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$523.20
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cigna Commercial |
$741.20
|
| Rate for Payer: First Health Commercial |
$784.80
|
| Rate for Payer: First Health Workers Compensation |
$336.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$784.80
|
| Rate for Payer: GEHA Commercial |
$697.60
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$784.80
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$793.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$610.40
|
| Rate for Payer: One Health Plan PPO/POS |
$784.80
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$828.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$654.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$348.80
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$238.06
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
6111010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.43 |
| Max. Negotiated Rate |
$1,534.25 |
| 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 |
$969.00
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,292.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,469.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,534.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$646.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$440.89
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
8111010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.89 |
| Max. Negotiated Rate |
$1,534.25 |
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,130.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| Rate for Payer: Multiplan All |
$1,469.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,534.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.95
|
| Rate for Payer: Zelis Auto |
$646.00
|
| Rate for Payer: Zelis Worker's Compensation |
$440.89
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
IP
|
$1,226.49
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
7211010
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$334.83 |
| Max. Negotiated Rate |
$1,165.17 |
| Rate for Payer: Cash Price |
$735.89
|
| Rate for Payer: Cigna Commercial |
$1,042.52
|
| Rate for Payer: First Health Commercial |
$1,103.84
|
| Rate for Payer: First Health Workers Compensation |
$473.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.84
|
| Rate for Payer: GEHA Commercial |
$858.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.84
|
| Rate for Payer: Multiplan All |
$1,116.11
|
| Rate for Payer: OMNI Networks Commercial |
$858.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,165.17
|
| Rate for Payer: Three Rivers Provider Network All |
$919.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.64
|
| Rate for Payer: Zelis Auto |
$490.60
|
| Rate for Payer: Zelis Worker's Compensation |
$334.83
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
OP
|
$1,226.49
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
7211010
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$334.83 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$735.89
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$735.89
|
| Rate for Payer: Cash Price |
$735.89
|
| Rate for Payer: Cigna Commercial |
$1,042.52
|
| Rate for Payer: First Health Commercial |
$1,103.84
|
| Rate for Payer: First Health Workers Compensation |
$473.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.84
|
| Rate for Payer: GEHA Commercial |
$981.19
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.84
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,116.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$858.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.84
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,165.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$919.87
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$490.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$334.83
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TIS
|
Facility
|
OP
|
$1,615.00
|
|
| Hospital Charge Code |
8111010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$403.75 |
| Max. Negotiated Rate |
$1,534.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$969.00
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,292.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| Rate for Payer: Humana ChoiceCare |
$419.90
|
| Rate for Payer: Multiplan All |
$1,469.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$969.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,534.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,421.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$403.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.95
|
| Rate for Payer: Zelis Auto |
$646.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$807.50
|
| Rate for Payer: Zelis Worker's Compensation |
$440.89
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKN SQ TMF MU
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
6111011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.67 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$467.40
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cigna Commercial |
$662.15
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: First Health Workers Compensation |
$300.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$701.10
|
| Rate for Payer: GEHA Commercial |
$623.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$701.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$708.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$545.30
|
| Rate for Payer: One Health Plan PPO/POS |
$701.10
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$740.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$584.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$724.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$311.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$212.67
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKN SQ TMF MU
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
21600501
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$349.43 |
| Max. Negotiated Rate |
$1,539.00 |
| 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 |
$972.00
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna Commercial |
$1,377.00
|
| Rate for Payer: First Health Commercial |
$1,458.00
|
| Rate for Payer: First Health Workers Compensation |
$625.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,458.00
|
| Rate for Payer: GEHA Commercial |
$1,296.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,458.00
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,474.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,134.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,458.00
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,539.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,215.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,506.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$648.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$442.26
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKN SQ TMF MU
|
Facility
|
OP
|
$1,474.00
|
|
| Hospital Charge Code |
8111011
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$1,400.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$884.40
|
| Rate for Payer: Cash Price |
$884.40
|
| Rate for Payer: Cigna Commercial |
$1,252.90
|
| Rate for Payer: First Health Commercial |
$1,326.60
|
| Rate for Payer: First Health Workers Compensation |
$569.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,326.60
|
| Rate for Payer: GEHA Commercial |
$1,179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,326.60
|
| Rate for Payer: Humana ChoiceCare |
$383.24
|
| Rate for Payer: Multiplan All |
$1,341.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$884.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,326.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,400.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,105.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,297.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$368.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,370.82
|
| Rate for Payer: Zelis Auto |
$589.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$737.00
|
| Rate for Payer: Zelis Worker's Compensation |
$402.40
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKN SQ TMF MU
|
Facility
|
IP
|
$1,474.00
|
|
| Hospital Charge Code |
8111011
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.40 |
| Max. Negotiated Rate |
$1,400.30 |
| Rate for Payer: Cash Price |
$884.40
|
| Rate for Payer: Cigna Commercial |
$1,252.90
|
| Rate for Payer: First Health Commercial |
$1,326.60
|
| Rate for Payer: First Health Workers Compensation |
$569.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,326.60
|
| Rate for Payer: GEHA Commercial |
$1,031.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,326.60
|
| Rate for Payer: Multiplan All |
$1,341.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,326.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,400.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,105.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,370.82
|
| Rate for Payer: Zelis Auto |
$589.60
|
| Rate for Payer: Zelis Worker's Compensation |
$402.40
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKN SQ TMF MU
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
6111011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.67 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cigna Commercial |
$662.15
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: First Health Workers Compensation |
$300.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$701.10
|
| Rate for Payer: GEHA Commercial |
$545.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$701.10
|
| Rate for Payer: Multiplan All |
$708.89
|
| Rate for Payer: OMNI Networks Commercial |
$545.30
|
| Rate for Payer: One Health Plan PPO/POS |
$701.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$740.05
|
| Rate for Payer: Three Rivers Provider Network All |
$584.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$724.47
|
| Rate for Payer: Zelis Auto |
$311.60
|
| Rate for Payer: Zelis Worker's Compensation |
$212.67
|
|
|
DBRDMT W/RMVL FM FX&/DISLC SKN SQ TMF MU
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
21600501
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$442.26 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna Commercial |
$1,377.00
|
| Rate for Payer: First Health Commercial |
$1,458.00
|
| Rate for Payer: First Health Workers Compensation |
$625.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,458.00
|
| Rate for Payer: GEHA Commercial |
$1,134.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,458.00
|
| Rate for Payer: Multiplan All |
$1,474.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,134.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,458.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,539.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,215.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,506.60
|
| Rate for Payer: Zelis Auto |
$648.00
|
| Rate for Payer: Zelis Worker's Compensation |
$442.26
|
|
|
DBRD OP WND 1ST 20 CM OR LESS - PROFEE
|
Facility
|
OP
|
$772.20
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9600125
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$733.59 |
| 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 |
$463.32
|
| 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 |
$188.67
|
| Rate for Payer: Cash Price |
$463.32
|
| Rate for Payer: Cash Price |
$463.32
|
| Rate for Payer: Cigna Commercial |
$656.37
|
| Rate for Payer: First Health Commercial |
$694.98
|
| Rate for Payer: First Health Workers Compensation |
$298.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$694.98
|
| Rate for Payer: GEHA Commercial |
$617.76
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$694.98
|
| 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 |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$702.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$540.54
|
| Rate for Payer: One Health Plan PPO/POS |
$694.98
|
| 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 |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$733.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$579.15
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$718.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$308.88
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$210.81
|
|
|
DBRD OP WND 1ST 20 CM OR LESS - PROFEE
|
Facility
|
IP
|
$772.20
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9600125
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$210.81 |
| Max. Negotiated Rate |
$733.59 |
| Rate for Payer: Cash Price |
$463.32
|
| Rate for Payer: Cigna Commercial |
$656.37
|
| Rate for Payer: First Health Commercial |
$694.98
|
| Rate for Payer: First Health Workers Compensation |
$298.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$694.98
|
| Rate for Payer: GEHA Commercial |
$540.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$694.98
|
| Rate for Payer: Multiplan All |
$702.70
|
| Rate for Payer: OMNI Networks Commercial |
$540.54
|
| Rate for Payer: One Health Plan PPO/POS |
$694.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$733.59
|
| Rate for Payer: Three Rivers Provider Network All |
$579.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$718.15
|
| Rate for Payer: Zelis Auto |
$308.88
|
| Rate for Payer: Zelis Worker's Compensation |
$210.81
|
|
|
D&C OF CERVICAL STUMP
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 57558
|
| Hospital Charge Code |
6157558
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$240.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
D&C OF CERVICAL STUMP
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 57558
|
| Hospital Charge Code |
6157558
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
DC-SULFA-TRIMETHOPRIM 200-40MG/5ML SUSP.
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 65862049647
|
| Hospital Charge Code |
3300867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
DC-SULFA-TRIMETHOPRIM 200-40MG/5ML SUSP.
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 65862049647
|
| Hospital Charge Code |
3300867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
D DIMER
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
2232164
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$15.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$97.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Worker's Compensation |
$11.03
|
|
|
D DIMER
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
2232164
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$83.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$15.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$111.20
|
| Rate for Payer: GEHA Medicare |
$10.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Humana ChoiceCare |
$11.20
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.18
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.31
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.36
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$118.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.18
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Medicare |
$8.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.22
|
| Rate for Payer: Zelis Worker's Compensation |
$11.03
|
|
|
DEBRIDE ABDOM WALL
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
6111005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$993.60
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cigna Commercial |
$1,407.60
|
| Rate for Payer: First Health Commercial |
$1,490.40
|
| Rate for Payer: First Health Workers Compensation |
$639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,490.40
|
| Rate for Payer: GEHA Commercial |
$1,324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,490.40
|
| Rate for Payer: Humana ChoiceCare |
$430.56
|
| Rate for Payer: Multiplan All |
$1,506.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$993.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,159.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,490.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,573.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,242.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,457.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,540.08
|
| Rate for Payer: Zelis Auto |
$662.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$828.00
|
| Rate for Payer: Zelis Worker's Compensation |
$452.09
|
|
|
DEBRIDE ABDOM WALL
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
6111005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.09 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cigna Commercial |
$1,407.60
|
| Rate for Payer: First Health Commercial |
$1,490.40
|
| Rate for Payer: First Health Workers Compensation |
$639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,490.40
|
| Rate for Payer: GEHA Commercial |
$1,159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,490.40
|
| Rate for Payer: Multiplan All |
$1,506.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,159.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,490.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,573.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,242.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,540.08
|
| Rate for Payer: Zelis Auto |
$662.40
|
| Rate for Payer: Zelis Worker's Compensation |
$452.09
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
6111004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.75 |
| Max. Negotiated Rate |
$1,158.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$731.40
|
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cigna Commercial |
$1,036.15
|
| Rate for Payer: First Health Commercial |
$1,097.10
|
| Rate for Payer: First Health Workers Compensation |
$470.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,097.10
|
| Rate for Payer: GEHA Commercial |
$975.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,097.10
|
| Rate for Payer: Humana ChoiceCare |
$316.94
|
| Rate for Payer: Multiplan All |
$1,109.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$731.40
|
| Rate for Payer: OMNI Networks Commercial |
$853.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,097.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,158.05
|
| Rate for Payer: Three Rivers Provider Network All |
$914.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,072.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,133.67
|
| Rate for Payer: Zelis Auto |
$487.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$609.50
|
| Rate for Payer: Zelis Worker's Compensation |
$332.79
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
6111004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.79 |
| Max. Negotiated Rate |
$1,158.05 |
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cigna Commercial |
$1,036.15
|
| Rate for Payer: First Health Commercial |
$1,097.10
|
| Rate for Payer: First Health Workers Compensation |
$470.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,097.10
|
| Rate for Payer: GEHA Commercial |
$853.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,097.10
|
| Rate for Payer: Multiplan All |
$1,109.29
|
| Rate for Payer: OMNI Networks Commercial |
$853.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,097.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,158.05
|
| Rate for Payer: Three Rivers Provider Network All |
$914.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,133.67
|
| Rate for Payer: Zelis Auto |
$487.60
|
| Rate for Payer: Zelis Worker's Compensation |
$332.79
|
|
