|
DEBRIDE GENIT/PER/ABDOM WALL
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 11006
|
| Hospital Charge Code |
6111006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$404.31 |
| Max. Negotiated Rate |
$1,406.95 |
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Cigna Commercial |
$1,258.85
|
| Rate for Payer: First Health Commercial |
$1,332.90
|
| Rate for Payer: First Health Workers Compensation |
$571.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.90
|
| Rate for Payer: GEHA Commercial |
$1,036.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.90
|
| Rate for Payer: Multiplan All |
$1,347.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,377.33
|
| Rate for Payer: Zelis Auto |
$592.40
|
| Rate for Payer: Zelis Worker's Compensation |
$404.31
|
|
|
DEBRIDE GENIT/PER/ABDOM WALL
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 11006
|
| Hospital Charge Code |
6111006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.25 |
| Max. Negotiated Rate |
$1,406.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$888.60
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Cigna Commercial |
$1,258.85
|
| Rate for Payer: First Health Commercial |
$1,332.90
|
| Rate for Payer: First Health Workers Compensation |
$571.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.90
|
| Rate for Payer: GEHA Commercial |
$1,184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.90
|
| Rate for Payer: Humana ChoiceCare |
$385.06
|
| Rate for Payer: Multiplan All |
$1,347.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$888.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,303.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$370.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,377.33
|
| Rate for Payer: Zelis Auto |
$592.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$740.50
|
| Rate for Payer: Zelis Worker's Compensation |
$404.31
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
OP
|
$3,557.90
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
9611047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.27 |
| Max. Negotiated Rate |
$3,380.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,134.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$680.27
|
| Rate for Payer: Cash Price |
$2,134.74
|
| Rate for Payer: Cash Price |
$2,134.74
|
| Rate for Payer: Cigna Commercial |
$3,024.22
|
| Rate for Payer: First Health Commercial |
$3,202.11
|
| Rate for Payer: First Health Workers Compensation |
$1,373.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,202.11
|
| Rate for Payer: GEHA Commercial |
$2,846.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,202.11
|
| Rate for Payer: Humana ChoiceCare |
$925.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$694.12
|
| Rate for Payer: Multiplan All |
$3,237.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,134.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,490.53
|
| Rate for Payer: One Health Plan PPO/POS |
$3,202.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$801.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$694.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,380.01
|
| Rate for Payer: Three Rivers Provider Network All |
$2,668.43
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,130.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$694.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,308.85
|
| Rate for Payer: Zelis Auto |
$1,423.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,778.95
|
| Rate for Payer: Zelis Worker's Compensation |
$971.31
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
1900006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.27 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$680.27
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$2,978.40
|
| Rate for Payer: First Health Commercial |
$3,153.60
|
| Rate for Payer: First Health Workers Compensation |
$1,352.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,153.60
|
| Rate for Payer: GEHA Commercial |
$2,803.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,153.60
|
| Rate for Payer: Humana ChoiceCare |
$911.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$694.12
|
| Rate for Payer: Multiplan All |
$3,188.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,102.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,153.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$801.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$694.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,328.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,083.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$694.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,258.72
|
| Rate for Payer: Zelis Auto |
$1,401.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,752.00
|
| Rate for Payer: Zelis Worker's Compensation |
$956.59
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
6111047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.27 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$122.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$221.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$86.27
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
IP
|
$3,557.90
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
9611047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$971.31 |
| Max. Negotiated Rate |
$3,380.01 |
| Rate for Payer: Cash Price |
$2,134.74
|
| Rate for Payer: Cigna Commercial |
$3,024.22
|
| Rate for Payer: First Health Commercial |
$3,202.11
|
| Rate for Payer: First Health Workers Compensation |
$1,373.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,202.11
|
| Rate for Payer: GEHA Commercial |
$2,490.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,202.11
|
| Rate for Payer: Multiplan All |
$3,237.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,490.53
|
| Rate for Payer: One Health Plan PPO/POS |
$3,202.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,380.01
|
| Rate for Payer: Three Rivers Provider Network All |
$2,668.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,308.85
|
| Rate for Payer: Zelis Auto |
$1,423.16
|
| Rate for Payer: Zelis Worker's Compensation |
$971.31
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
1900006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.59 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$2,978.40
|
| Rate for Payer: First Health Commercial |
$3,153.60
|
| Rate for Payer: First Health Workers Compensation |
$1,352.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,153.60
|
| Rate for Payer: GEHA Commercial |
$2,452.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,153.60
|
| Rate for Payer: Multiplan All |
$3,188.64
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,153.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,328.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,258.72
|
| Rate for Payer: Zelis Auto |
$1,401.60
|
| Rate for Payer: Zelis Worker's Compensation |
$956.59
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
20300006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$858.71 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$680.27
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Humana ChoiceCare |
$100.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$694.12
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$231.00
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$801.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$694.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$338.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$694.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$192.50
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
1000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.46 |
| Max. Negotiated Rate |
$1,278.70 |
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$1,144.10
|
| Rate for Payer: First Health Commercial |
$1,211.40
|
| Rate for Payer: First Health Workers Compensation |
$519.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,211.40
|
| Rate for Payer: GEHA Commercial |
$942.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,211.40
|
| Rate for Payer: Multiplan All |
$1,224.86
|
| Rate for Payer: OMNI Networks Commercial |
$942.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,211.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,278.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,009.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,251.78
|
| Rate for Payer: Zelis Auto |
$538.40
|
| Rate for Payer: Zelis Worker's Compensation |
$367.46
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
6111047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$858.71 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$858.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$680.27
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$122.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$252.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$694.12
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$189.60
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$801.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$694.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$278.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$694.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.27
|
|
|
DEBRIDEMENT BONE EACH ADDITIONL 20 SQ CM
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
20300006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
DEBRIDEMENT, BONE; FIRST 20 SQ CM OR LES
|
Facility
|
IP
|
$5,189.41
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
8111044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,416.71 |
| Max. Negotiated Rate |
$4,929.94 |
| Rate for Payer: Cash Price |
$3,113.65
|
| Rate for Payer: Cigna Commercial |
$4,411.00
|
| Rate for Payer: First Health Commercial |
$4,670.47
|
| Rate for Payer: First Health Workers Compensation |
$2,003.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,670.47
|
| Rate for Payer: GEHA Commercial |
$3,632.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,670.47
|
| Rate for Payer: Multiplan All |
$4,722.36
|
| Rate for Payer: OMNI Networks Commercial |
$3,632.59
|
| Rate for Payer: One Health Plan PPO/POS |
$4,670.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,929.94
|
| Rate for Payer: Three Rivers Provider Network All |
$3,892.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,826.15
|
| Rate for Payer: Zelis Auto |
$2,075.76
|
| Rate for Payer: Zelis Worker's Compensation |
$1,416.71
|
|
|
DEBRIDEMENT, BONE; FIRST 20 SQ CM OR LES
|
Facility
|
OP
|
$5,189.41
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
8111044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$4,929.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,113.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,113.65
|
| Rate for Payer: Cash Price |
$3,113.65
|
| Rate for Payer: Cigna Commercial |
$4,411.00
|
| Rate for Payer: First Health Commercial |
$4,670.47
|
| Rate for Payer: First Health Workers Compensation |
$2,003.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,670.47
|
| Rate for Payer: GEHA Commercial |
$4,151.53
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,670.47
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,722.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,632.59
|
| Rate for Payer: One Health Plan PPO/POS |
$4,670.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,929.94
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,892.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,826.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,075.76
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,416.71
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$377.34
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$377.34 |
| 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 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: First Health Workers Compensation |
$242.82
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| 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: New Mexico Health Connections Medicare |
$320.74
|
| 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 Worker's Compensation |
$377.34
|
| 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: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$171.69
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6169220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6169220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| 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 |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
8300055
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
8300055
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| 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 |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: First Health Workers Compensation |
$748.06
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$528.93
|
|
|
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
20300003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.37 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$270.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$490.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Worker's Compensation |
$191.37
|
|
|
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
1900003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$938.85 |
| Max. Negotiated Rate |
$3,267.05 |
| Rate for Payer: Cash Price |
$2,063.40
|
| Rate for Payer: Cigna Commercial |
$2,923.15
|
| Rate for Payer: First Health Commercial |
$3,095.10
|
| Rate for Payer: First Health Workers Compensation |
$1,327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,095.10
|
| Rate for Payer: GEHA Commercial |
$2,407.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,095.10
|
| Rate for Payer: Multiplan All |
$3,129.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,407.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,095.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,267.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,579.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,198.27
|
| Rate for Payer: Zelis Auto |
$1,375.60
|
| Rate for Payer: Zelis Worker's Compensation |
$938.85
|
|
|
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
20300003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.37 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$270.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$560.80
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$191.37
|
|
|
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$669.18
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
6111043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.69 |
| Max. Negotiated Rate |
$635.72 |
| Rate for Payer: Cash Price |
$401.51
|
| Rate for Payer: Cigna Commercial |
$568.80
|
| Rate for Payer: First Health Commercial |
$602.26
|
| Rate for Payer: First Health Workers Compensation |
$258.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$602.26
|
| Rate for Payer: GEHA Commercial |
$468.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$602.26
|
| Rate for Payer: Multiplan All |
$608.95
|
| Rate for Payer: OMNI Networks Commercial |
$468.43
|
| Rate for Payer: One Health Plan PPO/POS |
$602.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.72
|
| Rate for Payer: Three Rivers Provider Network All |
$501.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$622.34
|
| Rate for Payer: Zelis Auto |
$267.67
|
| Rate for Payer: Zelis Worker's Compensation |
$182.69
|
|
|
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
2700234
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.37 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$270.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$490.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Worker's Compensation |
$191.37
|
|
|
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Facility
|
OP
|
$669.18
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
6111043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.69 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$401.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$282.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$401.51
|
| Rate for Payer: Cash Price |
$401.51
|
| Rate for Payer: Cigna Commercial |
$568.80
|
| Rate for Payer: First Health Commercial |
$602.26
|
| Rate for Payer: First Health Workers Compensation |
$258.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$602.26
|
| Rate for Payer: GEHA Commercial |
$535.34
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$602.26
|
| 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 |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$608.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$468.43
|
| Rate for Payer: One Health Plan PPO/POS |
$602.26
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$264.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$228.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$635.72
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$501.88
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$622.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$267.67
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$182.69
|
|
