|
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
|
OP
|
$3,439.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
1900003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$3,267.05 |
| 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 |
$2,063.40
|
| 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 |
$593.14
|
| Rate for Payer: Cash Price |
$2,063.40
|
| 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 |
$2,751.20
|
| Rate for Payer: GEHA Medicare |
$593.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,095.10
|
| Rate for Payer: Humana ChoiceCare |
$652.45
|
| Rate for Payer: Humana Medicare Advantage |
$593.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$996.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$593.14
|
| Rate for Payer: Multiplan All |
$3,129.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,008.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,407.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,095.10
|
| 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 |
$593.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,267.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,186.28
|
| Rate for Payer: Three Rivers Provider Network All |
$2,579.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$581.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$593.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,198.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$593.14
|
| Rate for Payer: Zelis Auto |
$1,375.60
|
| Rate for Payer: Zelis Medicare |
$504.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.77
|
| 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 |
$1,186.28 |
| 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 |
$593.14
|
| 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 |
$593.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| Rate for Payer: Humana ChoiceCare |
$652.45
|
| Rate for Payer: Humana Medicare Advantage |
$593.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$996.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$593.14
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,008.34
|
| 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 |
$593.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,186.28
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$581.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$593.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$593.14
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Medicare |
$504.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.77
|
| Rate for Payer: Zelis Worker's Compensation |
$191.37
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
8711720
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
20300104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9611720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$228.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
21600083
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| 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 |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| 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: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| 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 |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
21600083
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
1911720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: First Health Workers Compensation |
$113.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$236.00
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$80.53
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
20300104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
8300014
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
8711720
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$115.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
8300014
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
1911720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.53 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: First Health Workers Compensation |
$113.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$206.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.53
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9611720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$261.60
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
8300015
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
6111721
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
8300015
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
6111721
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
20300105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
20300105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
1911721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: First Health Workers Compensation |
$129.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Worker's Compensation |
$91.73
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
1911721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: First Health Workers Compensation |
$129.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$91.73
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$362.70
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9611721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.02 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Cash Price |
$217.62
|
| Rate for Payer: Cigna Commercial |
$308.30
|
| Rate for Payer: First Health Commercial |
$326.43
|
| Rate for Payer: First Health Workers Compensation |
$140.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.43
|
| Rate for Payer: GEHA Commercial |
$253.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.43
|
| Rate for Payer: Multiplan All |
$330.06
|
| Rate for Payer: OMNI Networks Commercial |
$253.89
|
| Rate for Payer: One Health Plan PPO/POS |
$326.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.56
|
| Rate for Payer: Three Rivers Provider Network All |
$272.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.31
|
| Rate for Payer: Zelis Auto |
$145.08
|
| Rate for Payer: Zelis Worker's Compensation |
$99.02
|
|
|
DEBRIDEMENT NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$362.70
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9611721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$217.62
|
| Rate for Payer: Cash Price |
$217.62
|
| Rate for Payer: Cigna Commercial |
$308.30
|
| Rate for Payer: First Health Commercial |
$326.43
|
| Rate for Payer: First Health Workers Compensation |
$140.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.43
|
| Rate for Payer: GEHA Commercial |
$290.16
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.43
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$330.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$253.89
|
| Rate for Payer: One Health Plan PPO/POS |
$326.43
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$272.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$145.08
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$99.02
|
|
