|
EXC FACE LES SC <2 CM
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 21011
|
| Hospital Charge Code |
6121011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.36 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$558.45
|
| Rate for Payer: First Health Commercial |
$591.30
|
| Rate for Payer: First Health Workers Compensation |
$253.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.30
|
| Rate for Payer: GEHA Commercial |
$459.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.30
|
| Rate for Payer: Multiplan All |
$597.87
|
| Rate for Payer: OMNI Networks Commercial |
$459.90
|
| Rate for Payer: One Health Plan PPO/POS |
$591.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.15
|
| Rate for Payer: Three Rivers Provider Network All |
$492.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.01
|
| Rate for Payer: Zelis Auto |
$262.80
|
| Rate for Payer: Zelis Worker's Compensation |
$179.36
|
|
|
EXC FACE-MM MALIG+MARG 0.5 <
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
6111640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
EXC FACE-MM MALIG+MARG 0.5 <
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
6111640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
EXC FACE-MM MALIG+MARG 0.6-1
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
6111641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cigna Commercial |
$406.30
|
| Rate for Payer: First Health Commercial |
$430.20
|
| Rate for Payer: First Health Workers Compensation |
$184.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$430.20
|
| Rate for Payer: GEHA Commercial |
$382.40
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$430.20
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$434.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$334.60
|
| Rate for Payer: One Health Plan PPO/POS |
$430.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$454.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$358.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$444.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$191.20
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$130.49
|
|
|
EXC FACE-MM MALIG+MARG 0.6-1
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
6111641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cigna Commercial |
$406.30
|
| Rate for Payer: First Health Commercial |
$430.20
|
| Rate for Payer: First Health Workers Compensation |
$184.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$430.20
|
| Rate for Payer: GEHA Commercial |
$334.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$430.20
|
| Rate for Payer: Multiplan All |
$434.98
|
| Rate for Payer: OMNI Networks Commercial |
$334.60
|
| Rate for Payer: One Health Plan PPO/POS |
$430.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$454.10
|
| Rate for Payer: Three Rivers Provider Network All |
$358.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$444.54
|
| Rate for Payer: Zelis Auto |
$191.20
|
| Rate for Payer: Zelis Worker's Compensation |
$130.49
|
|
|
EXC FACE-MM MALIG+MARG 1.1-2
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
6111642
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$395.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
|
EXC FACE-MM MALIG+MARG 1.1-2
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
6111642
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$452.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
|
EXC FACE-MM MALIG+MARG 2.1-3
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
6111643
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$561.45 |
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$502.35
|
| Rate for Payer: First Health Commercial |
$531.90
|
| Rate for Payer: First Health Workers Compensation |
$228.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.90
|
| Rate for Payer: GEHA Commercial |
$413.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.90
|
| Rate for Payer: Multiplan All |
$537.81
|
| Rate for Payer: OMNI Networks Commercial |
$413.70
|
| Rate for Payer: One Health Plan PPO/POS |
$531.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$561.45
|
| Rate for Payer: Three Rivers Provider Network All |
$443.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$549.63
|
| Rate for Payer: Zelis Auto |
$236.40
|
| Rate for Payer: Zelis Worker's Compensation |
$161.34
|
|
|
EXC FACE-MM MALIG+MARG 2.1-3
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
6111643
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$354.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$502.35
|
| Rate for Payer: First Health Commercial |
$531.90
|
| Rate for Payer: First Health Workers Compensation |
$228.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.90
|
| Rate for Payer: GEHA Commercial |
$472.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.90
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$537.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$413.70
|
| Rate for Payer: One Health Plan PPO/POS |
$531.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$561.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$443.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$549.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$236.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$161.34
|
|
|
EXC FACE-MM MALIG+MARG 3.1-4
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
6111644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.11 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$439.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$623.05
|
| Rate for Payer: First Health Commercial |
$659.70
|
| Rate for Payer: First Health Workers Compensation |
$283.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$659.70
|
| Rate for Payer: GEHA Commercial |
$586.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$659.70
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$667.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$513.10
|
| Rate for Payer: One Health Plan PPO/POS |
$659.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$696.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$549.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$681.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$293.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$200.11
|
|
|
EXC FACE-MM MALIG+MARG 3.1-4
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
6111644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.11 |
| Max. Negotiated Rate |
$696.35 |
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$623.05
|
| Rate for Payer: First Health Commercial |
$659.70
|
| Rate for Payer: First Health Workers Compensation |
$283.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$659.70
|
| Rate for Payer: GEHA Commercial |
$513.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$659.70
|
| Rate for Payer: Multiplan All |
$667.03
|
| Rate for Payer: OMNI Networks Commercial |
$513.10
|
| Rate for Payer: One Health Plan PPO/POS |
$659.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$696.35
|
| Rate for Payer: Three Rivers Provider Network All |
$549.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$681.69
|
| Rate for Payer: Zelis Auto |
$293.20
|
| Rate for Payer: Zelis Worker's Compensation |
$200.11
|
|
|
EXC FACE-MM MLG+MARG > 4 CM
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
6111646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$490.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$654.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$327.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$223.31
|
|
|
EXC FACE-MM MLG+MARG > 4 CM
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
6111646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$572.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: Zelis Auto |
$327.20
|
| Rate for Payer: Zelis Worker's Compensation |
$223.31
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 21013
|
| Hospital Charge Code |
6121013
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$656.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 21013
|
| Hospital Charge Code |
6121013
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$779.00 |
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$574.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 21014
|
| Hospital Charge Code |
6121014
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$854.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$427.20
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$291.56
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT 21014
|
| Hospital Charge Code |
6121014
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$1,014.60 |
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$747.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: Zelis Auto |
$427.20
|
| Rate for Payer: Zelis Worker's Compensation |
$291.56
|
|
|
EXC FOOT/TOE TUM DEEP <1.5CM
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 28045
|
| Hospital Charge Code |
6128045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$531.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$342.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$708.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$806.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$841.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$241.88
|
|
|
EXC FOOT/TOE TUM DEEP <1.5CM
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 28045
|
| Hospital Charge Code |
6128045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$841.70 |
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$342.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$620.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| Rate for Payer: Multiplan All |
$806.26
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$841.70
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.98
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Worker's Compensation |
$241.88
|
|
|
EXC FOOT/TOE TUM DEEP 1.5CM+
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 28041
|
| Hospital Charge Code |
6128041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$803.25
|
| Rate for Payer: First Health Commercial |
$850.50
|
| Rate for Payer: First Health Workers Compensation |
$364.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$850.50
|
| Rate for Payer: GEHA Commercial |
$661.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$850.50
|
| Rate for Payer: Multiplan All |
$859.95
|
| Rate for Payer: OMNI Networks Commercial |
$661.50
|
| Rate for Payer: One Health Plan PPO/POS |
$850.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$897.75
|
| Rate for Payer: Three Rivers Provider Network All |
$708.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$878.85
|
| Rate for Payer: Zelis Auto |
$378.00
|
| Rate for Payer: Zelis Worker's Compensation |
$257.99
|
|
|
EXC FOOT/TOE TUM DEEP 1.5CM+
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 28041
|
| Hospital Charge Code |
6128041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$567.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$803.25
|
| Rate for Payer: First Health Commercial |
$850.50
|
| Rate for Payer: First Health Workers Compensation |
$364.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$850.50
|
| Rate for Payer: GEHA Commercial |
$756.00
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$850.50
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$859.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$661.50
|
| Rate for Payer: One Health Plan PPO/POS |
$850.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$897.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$708.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$878.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$378.00
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$257.99
|
|
|
EXC FOOT/TOE TUM SC < 1.5 CM
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
6128043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.36 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$567.80
|
| Rate for Payer: First Health Commercial |
$601.20
|
| Rate for Payer: First Health Workers Compensation |
$257.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.20
|
| Rate for Payer: GEHA Commercial |
$534.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.20
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$607.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$467.60
|
| Rate for Payer: One Health Plan PPO/POS |
$601.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$634.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$501.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$621.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$267.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$182.36
|
|
|
EXC FOOT/TOE TUM SC < 1.5 CM
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
6128043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.36 |
| Max. Negotiated Rate |
$634.60 |
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$567.80
|
| Rate for Payer: First Health Commercial |
$601.20
|
| Rate for Payer: First Health Workers Compensation |
$257.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.20
|
| Rate for Payer: GEHA Commercial |
$467.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.20
|
| Rate for Payer: Multiplan All |
$607.88
|
| Rate for Payer: OMNI Networks Commercial |
$467.60
|
| Rate for Payer: One Health Plan PPO/POS |
$601.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$634.60
|
| Rate for Payer: Three Rivers Provider Network All |
$501.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$621.24
|
| Rate for Payer: Zelis Auto |
$267.20
|
| Rate for Payer: Zelis Worker's Compensation |
$182.36
|
|
|
EXC FOOT/TOE TUM SC 1.5 CM/>
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
6128039
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.43 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: First Health Workers Compensation |
$347.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$629.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
| Rate for Payer: Zelis Worker's Compensation |
$245.43
|
|
|
EXC FOOT/TOE TUM SC 1.5 CM/>
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
6128039
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.43 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$539.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: First Health Workers Compensation |
$347.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$719.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$359.60
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$245.43
|
|
