|
DEBRIDEMENT OPEN WOUND 1ST 20 CM OR LESS
|
Facility
|
IP
|
$2,033.61
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8197597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$555.18 |
| Max. Negotiated Rate |
$1,931.93 |
| Rate for Payer: Cash Price |
$1,220.17
|
| Rate for Payer: Cigna Commercial |
$1,728.57
|
| Rate for Payer: First Health Commercial |
$1,830.25
|
| Rate for Payer: First Health Workers Compensation |
$785.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,830.25
|
| Rate for Payer: GEHA Commercial |
$1,423.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,830.25
|
| Rate for Payer: Multiplan All |
$1,850.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,423.53
|
| Rate for Payer: One Health Plan PPO/POS |
$1,830.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,931.93
|
| Rate for Payer: Three Rivers Provider Network All |
$1,525.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,891.26
|
| Rate for Payer: Zelis Auto |
$813.44
|
| Rate for Payer: Zelis Worker's Compensation |
$555.18
|
|
|
DEBRIDEMENT OPEN WOUND 1ST 20 CM OR LESS
|
Facility
|
OP
|
$2,033.61
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8197597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$1,931.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,220.17
|
| 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 |
$1,220.17
|
| Rate for Payer: Cash Price |
$1,220.17
|
| Rate for Payer: Cigna Commercial |
$1,728.57
|
| Rate for Payer: First Health Commercial |
$1,830.25
|
| Rate for Payer: First Health Workers Compensation |
$785.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,830.25
|
| Rate for Payer: GEHA Commercial |
$1,626.89
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,830.25
|
| 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 |
$1,850.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,423.53
|
| Rate for Payer: One Health Plan PPO/POS |
$1,830.25
|
| 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 |
$1,931.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,525.21
|
| 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 |
$1,891.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$813.44
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$555.18
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
21600207
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
21600207
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.98 |
| 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 Community HMO |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$208.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| 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 |
$236.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| 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 |
$241.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
OP
|
$770.54
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9697597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$732.01 |
| 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 |
$462.32
|
| 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 |
$462.32
|
| Rate for Payer: Cash Price |
$462.32
|
| Rate for Payer: Cigna Commercial |
$654.96
|
| Rate for Payer: First Health Commercial |
$693.49
|
| Rate for Payer: First Health Workers Compensation |
$297.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.49
|
| Rate for Payer: GEHA Commercial |
$616.43
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.49
|
| 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 |
$701.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$539.38
|
| Rate for Payer: One Health Plan PPO/POS |
$693.49
|
| 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 |
$732.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$577.90
|
| 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 |
$716.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$308.22
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$210.36
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
1997597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$653.60 |
| 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 |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: First Health Commercial |
$619.20
|
| Rate for Payer: First Health Workers Compensation |
$265.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$619.20
|
| Rate for Payer: GEHA Commercial |
$550.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$619.20
|
| 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 |
$626.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$481.60
|
| Rate for Payer: One Health Plan PPO/POS |
$619.20
|
| 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 |
$653.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$516.00
|
| 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 |
$639.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$275.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$187.82
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8797597
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
1000051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: First Health Commercial |
$511.20
|
| Rate for Payer: First Health Workers Compensation |
$219.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.20
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Worker's Compensation |
$155.06
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
1997597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$653.60 |
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: First Health Commercial |
$619.20
|
| Rate for Payer: First Health Workers Compensation |
$265.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$619.20
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$619.20
|
| Rate for Payer: Multiplan All |
$626.08
|
| Rate for Payer: OMNI Networks Commercial |
$481.60
|
| Rate for Payer: One Health Plan PPO/POS |
$619.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$653.60
|
| Rate for Payer: Three Rivers Provider Network All |
$516.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$639.84
|
| Rate for Payer: Zelis Auto |
$275.20
|
| Rate for Payer: Zelis Worker's Compensation |
$187.82
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$770.54
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9697597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.36 |
| Max. Negotiated Rate |
$732.01 |
| Rate for Payer: Cash Price |
$462.32
|
| Rate for Payer: Cigna Commercial |
$654.96
|
| Rate for Payer: First Health Commercial |
$693.49
|
| Rate for Payer: First Health Workers Compensation |
$297.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.49
|
| Rate for Payer: GEHA Commercial |
$539.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.49
|
| Rate for Payer: Multiplan All |
$701.19
|
| Rate for Payer: OMNI Networks Commercial |
$539.38
|
| Rate for Payer: One Health Plan PPO/POS |
$693.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.01
|
| Rate for Payer: Three Rivers Provider Network All |
$577.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.60
|
| Rate for Payer: Zelis Auto |
$308.22
|
| Rate for Payer: Zelis Worker's Compensation |
$210.36
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
8797597
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.98 |
| 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 Community HMO |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$208.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| 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 |
$236.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| 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 |
$241.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
20300102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
20300102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.98 |
| 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 Community HMO |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$208.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| 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 |
$236.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| 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 |
$241.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8797598
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$155.84 |
| 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 |
$49.20
|
| 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: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9697598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: First Health Workers Compensation |
$223.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$404.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
| Rate for Payer: Zelis Worker's Compensation |
$157.79
|
|
|
DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9697598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$549.10 |
| 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 |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: First Health Workers Compensation |
$223.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$462.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Humana ChoiceCare |
$150.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$346.80
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$508.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.00
|
| Rate for Payer: Zelis Worker's Compensation |
$157.79
|
|
|
DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8797598
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADD 20 SQ CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
6197598
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$155.84 |
| 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 |
$45.60
|
| 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: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$29.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$19.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.60
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$20.75
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADD 20 SQ CM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
6197598
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$29.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.75
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADD'L 20 CM
|
Facility
|
IP
|
$1,954.50
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8197598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.58 |
| Max. Negotiated Rate |
$1,856.78 |
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cigna Commercial |
$1,661.33
|
| Rate for Payer: First Health Commercial |
$1,759.05
|
| Rate for Payer: First Health Workers Compensation |
$754.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,759.05
|
| Rate for Payer: GEHA Commercial |
$1,368.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,759.05
|
| Rate for Payer: Multiplan All |
$1,778.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,368.15
|
| Rate for Payer: One Health Plan PPO/POS |
$1,759.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,856.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,465.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,817.68
|
| Rate for Payer: Zelis Auto |
$781.80
|
| Rate for Payer: Zelis Worker's Compensation |
$533.58
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADD'L 20 CM
|
Facility
|
OP
|
$1,954.50
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8197598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$1,856.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,172.70
|
| 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: Cash Price |
$1,172.70
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cigna Commercial |
$1,661.33
|
| Rate for Payer: First Health Commercial |
$1,759.05
|
| Rate for Payer: First Health Workers Compensation |
$754.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,759.05
|
| Rate for Payer: GEHA Commercial |
$1,563.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,759.05
|
| Rate for Payer: Humana ChoiceCare |
$508.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$1,778.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,172.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,368.15
|
| Rate for Payer: One Health Plan PPO/POS |
$1,759.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,856.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,465.88
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,719.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,817.68
|
| Rate for Payer: Zelis Auto |
$781.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$977.25
|
| Rate for Payer: Zelis Worker's Compensation |
$533.58
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADDL 20 CM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
20300103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$155.84 |
| 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 |
$49.20
|
| 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: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADDL 20 CM
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
20300103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADDL 20 CM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
1000052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
DEBRIDEMENT OPEN WOUND EACH ADDL 20 CM
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
1997598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
