|
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, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$758.74
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$758.74 |
| 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 |
$379.37
|
| Rate for Payer: First Health Workers Compensation |
$488.25
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$228.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$345.23
|
|
|
DEBRIDE MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
9611046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.99 |
| Max. Negotiated Rate |
$1,847.75 |
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,653.25
|
| Rate for Payer: First Health Commercial |
$1,750.50
|
| Rate for Payer: First Health Workers Compensation |
$750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,750.50
|
| Rate for Payer: GEHA Commercial |
$1,361.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,750.50
|
| Rate for Payer: Multiplan All |
$1,769.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,361.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,750.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,847.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,458.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,808.85
|
| Rate for Payer: Zelis Auto |
$778.00
|
| Rate for Payer: Zelis Worker's Compensation |
$530.99
|
|
|
DEBRIDE MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$1,945.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
9611046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$1,847.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,167.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$218.81
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,653.25
|
| Rate for Payer: First Health Commercial |
$1,750.50
|
| Rate for Payer: First Health Workers Compensation |
$750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,750.50
|
| Rate for Payer: GEHA Commercial |
$1,556.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,750.50
|
| Rate for Payer: Humana ChoiceCare |
$505.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$223.27
|
| Rate for Payer: Multiplan All |
$1,769.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,167.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,361.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,750.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$257.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$223.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,847.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,458.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,711.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,808.85
|
| Rate for Payer: Zelis Auto |
$778.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$972.50
|
| Rate for Payer: Zelis Worker's Compensation |
$530.99
|
|
|
DEBRIDE NAIL 6 OR MORE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
8711721
|
|
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 |
$56.40
|
| 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 |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| 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 |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
DEBRIDE NAIL 6 OR MORE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
8711721
|
|
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
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
1936593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.86 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$628.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna Commercial |
$889.95
|
| Rate for Payer: First Health Commercial |
$942.30
|
| Rate for Payer: First Health Workers Compensation |
$404.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$942.30
|
| Rate for Payer: GEHA Commercial |
$837.60
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$942.30
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$952.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$732.90
|
| Rate for Payer: One Health Plan PPO/POS |
$942.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$994.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$785.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$973.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$418.80
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$285.83
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
6136593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.86 |
| Max. Negotiated Rate |
$727.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$651.10
|
| Rate for Payer: First Health Commercial |
$689.40
|
| Rate for Payer: First Health Workers Compensation |
$295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.40
|
| Rate for Payer: GEHA Commercial |
$612.80
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.40
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$697.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$536.20
|
| Rate for Payer: One Health Plan PPO/POS |
$689.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$727.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$574.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$306.40
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$209.12
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
1936593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.83 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna Commercial |
$889.95
|
| Rate for Payer: First Health Commercial |
$942.30
|
| Rate for Payer: First Health Workers Compensation |
$404.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$942.30
|
| Rate for Payer: GEHA Commercial |
$732.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$942.30
|
| Rate for Payer: Multiplan All |
$952.77
|
| Rate for Payer: OMNI Networks Commercial |
$732.90
|
| Rate for Payer: One Health Plan PPO/POS |
$942.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$994.65
|
| Rate for Payer: Three Rivers Provider Network All |
$785.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$973.71
|
| Rate for Payer: Zelis Auto |
$418.80
|
| Rate for Payer: Zelis Worker's Compensation |
$285.83
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
6136593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$727.70 |
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$651.10
|
| Rate for Payer: First Health Commercial |
$689.40
|
| Rate for Payer: First Health Workers Compensation |
$295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.40
|
| Rate for Payer: GEHA Commercial |
$536.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.40
|
| Rate for Payer: Multiplan All |
$697.06
|
| Rate for Payer: OMNI Networks Commercial |
$536.20
|
| Rate for Payer: One Health Plan PPO/POS |
$689.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$727.70
|
| Rate for Payer: Three Rivers Provider Network All |
$574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.38
|
| Rate for Payer: Zelis Auto |
$306.40
|
| Rate for Payer: Zelis Worker's Compensation |
$209.12
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
OP
|
$92.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
7836593
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$314.95
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cigna Commercial |
$78.34
|
| Rate for Payer: First Health Commercial |
$82.94
|
| Rate for Payer: First Health Workers Compensation |
$35.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.94
|
| Rate for Payer: GEHA Commercial |
$73.73
|
| Rate for Payer: GEHA Medicare |
$314.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.94
|
| Rate for Payer: Humana ChoiceCare |
$346.44
|
| Rate for Payer: Humana Medicare Advantage |
$314.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$529.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$314.95
|
| Rate for Payer: Multiplan All |
$83.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.41
|
| Rate for Payer: OMNI Networks Commercial |
$64.51
|
| Rate for Payer: One Health Plan PPO/POS |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$314.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$629.90
|
| Rate for Payer: Three Rivers Provider Network All |
$69.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.65
|
| Rate for Payer: United Healthcare Commercial |
$78.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$314.95
|
| Rate for Payer: Zelis Auto |
$36.86
|
| Rate for Payer: Zelis Medicare |
$267.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$377.94
|
| Rate for Payer: Zelis Worker's Compensation |
$25.16
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
1000043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$727.70 |
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$651.10
|
| Rate for Payer: First Health Commercial |
$689.40
|
| Rate for Payer: First Health Workers Compensation |
$295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.40
|
| Rate for Payer: GEHA Commercial |
$536.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.40
|
| Rate for Payer: Multiplan All |
$697.06
|
| Rate for Payer: OMNI Networks Commercial |
$536.20
|
| Rate for Payer: One Health Plan PPO/POS |
$689.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$727.70
|
| Rate for Payer: Three Rivers Provider Network All |
$574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.38
|
| Rate for Payer: Zelis Auto |
$306.40
|
| Rate for Payer: Zelis Worker's Compensation |
$209.12
|
|
|
DECLOT THROMBOLYTIC AGNT IMPLNT DEV/CATH
|
Facility
|
IP
|
$92.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
7836593
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cigna Commercial |
$78.34
|
| Rate for Payer: First Health Commercial |
$82.94
|
| Rate for Payer: First Health Workers Compensation |
$35.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.94
|
| Rate for Payer: GEHA Commercial |
$64.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.94
|
| Rate for Payer: Multiplan All |
$83.87
|
| Rate for Payer: OMNI Networks Commercial |
$64.51
|
| Rate for Payer: One Health Plan PPO/POS |
$82.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.55
|
| Rate for Payer: Three Rivers Provider Network All |
$69.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.71
|
| Rate for Payer: Zelis Auto |
$36.86
|
| Rate for Payer: Zelis Worker's Compensation |
$25.16
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 26037
|
| Hospital Charge Code |
6126037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$808.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
CPT 26035
|
| Hospital Charge Code |
6126035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.93 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,041.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$1,475.60
|
| Rate for Payer: First Health Commercial |
$1,562.40
|
| Rate for Payer: First Health Workers Compensation |
$670.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,562.40
|
| Rate for Payer: GEHA Commercial |
$1,388.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,562.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,579.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,215.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,562.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,649.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,614.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$694.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$473.93
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 26037
|
| Hospital Charge Code |
6126037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
CPT 26035
|
| Hospital Charge Code |
6126035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.93 |
| Max. Negotiated Rate |
$1,649.20 |
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$1,475.60
|
| Rate for Payer: First Health Commercial |
$1,562.40
|
| Rate for Payer: First Health Workers Compensation |
$670.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,562.40
|
| Rate for Payer: GEHA Commercial |
$1,215.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,562.40
|
| Rate for Payer: Multiplan All |
$1,579.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,215.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,562.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,649.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,614.48
|
| Rate for Payer: Zelis Auto |
$694.40
|
| Rate for Payer: Zelis Worker's Compensation |
$473.93
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 25020
|
| Hospital Charge Code |
6125020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.50 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: First Health Workers Compensation |
$444.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Worker's Compensation |
$314.50
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 25020
|
| Hospital Charge Code |
6125020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.50 |
| Max. Negotiated Rate |
$3,212.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: First Health Workers Compensation |
$444.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$314.50
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Facility
|
OP
|
$2,235.00
|
|
|
Service Code
|
CPT 25023
|
| Hospital Charge Code |
6125023
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$610.15 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,341.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: First Health Workers Compensation |
$862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,788.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$610.15
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Facility
|
IP
|
$2,235.00
|
|
|
Service Code
|
CPT 25023
|
| Hospital Charge Code |
6125023
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$610.15 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: First Health Workers Compensation |
$862.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,564.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Worker's Compensation |
$610.15
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT 25024
|
| Hospital Charge Code |
6125024
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.43 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: First Health Commercial |
$1,425.60
|
| Rate for Payer: First Health Workers Compensation |
$611.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,425.60
|
| Rate for Payer: GEHA Commercial |
$1,108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,425.60
|
| Rate for Payer: Multiplan All |
$1,441.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,108.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,425.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,504.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,188.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,473.12
|
| Rate for Payer: Zelis Auto |
$633.60
|
| Rate for Payer: Zelis Worker's Compensation |
$432.43
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
OP
|
$2,482.00
|
|
|
Service Code
|
CPT 25025
|
| Hospital Charge Code |
6125025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.59 |
| Max. Negotiated Rate |
$3,212.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,489.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,985.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT 25024
|
| Hospital Charge Code |
6125024
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.43 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$950.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: First Health Commercial |
$1,425.60
|
| Rate for Payer: First Health Workers Compensation |
$611.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,425.60
|
| Rate for Payer: GEHA Commercial |
$1,267.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,425.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,441.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,108.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,425.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,504.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,188.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,473.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$633.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$432.43
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
IP
|
$2,482.00
|
|
|
Service Code
|
CPT 25025
|
| Hospital Charge Code |
6125025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.59 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,737.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
