|
EXC FOREARM LES SC < 3 CM
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
6125075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.31 |
| 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 |
$484.20
|
| 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 |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cigna Commercial |
$685.95
|
| Rate for Payer: First Health Commercial |
$726.30
|
| Rate for Payer: First Health Workers Compensation |
$311.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$726.30
|
| Rate for Payer: GEHA Commercial |
$645.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$726.30
|
| 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 |
$734.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$564.90
|
| Rate for Payer: One Health Plan PPO/POS |
$726.30
|
| 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 |
$766.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$605.25
|
| 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 |
$750.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$322.80
|
| 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 |
$220.31
|
|
|
EXC FOREARM LES SC < 3 CM
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
6125075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.31 |
| Max. Negotiated Rate |
$766.65 |
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cigna Commercial |
$685.95
|
| Rate for Payer: First Health Commercial |
$726.30
|
| Rate for Payer: First Health Workers Compensation |
$311.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$726.30
|
| Rate for Payer: GEHA Commercial |
$564.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$726.30
|
| Rate for Payer: Multiplan All |
$734.37
|
| Rate for Payer: OMNI Networks Commercial |
$564.90
|
| Rate for Payer: One Health Plan PPO/POS |
$726.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$766.65
|
| Rate for Payer: Three Rivers Provider Network All |
$605.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$750.51
|
| Rate for Payer: Zelis Auto |
$322.80
|
| Rate for Payer: Zelis Worker's Compensation |
$220.31
|
|
|
EXC FOREARM LES SC 3 CM/>
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 25071
|
| Hospital Charge Code |
6125071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$525.60
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$350.40
|
| 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 |
$239.15
|
|
|
EXC FOREARM LES SC 3 CM/>
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 25071
|
| Hospital Charge Code |
6125071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 25076
|
| Hospital Charge Code |
6125076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.47 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$895.05
|
| Rate for Payer: First Health Commercial |
$947.70
|
| Rate for Payer: First Health Workers Compensation |
$406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$947.70
|
| Rate for Payer: GEHA Commercial |
$737.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| Rate for Payer: Multiplan All |
$958.23
|
| Rate for Payer: OMNI Networks Commercial |
$737.10
|
| Rate for Payer: One Health Plan PPO/POS |
$947.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,000.35
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$979.29
|
| Rate for Payer: Zelis Auto |
$421.20
|
| Rate for Payer: Zelis Worker's Compensation |
$287.47
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 25076
|
| Hospital Charge Code |
6125076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.47 |
| 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 |
$631.80
|
| 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 |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$895.05
|
| Rate for Payer: First Health Commercial |
$947.70
|
| Rate for Payer: First Health Workers Compensation |
$406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$947.70
|
| Rate for Payer: GEHA Commercial |
$842.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| 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 |
$958.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$737.10
|
| Rate for Payer: One Health Plan PPO/POS |
$947.70
|
| 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 |
$1,000.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| 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 |
$979.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$421.20
|
| 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 |
$287.47
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
6125073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Worker's Compensation |
$297.02
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
6125073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| 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 |
$652.80
|
| 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 |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$870.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| 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 |
$990.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| 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 |
$1,033.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| 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 |
$1,011.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$435.20
|
| 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 |
$297.02
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
6126115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$588.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
6126115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.32 |
| 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 |
$504.00
|
| 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 |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| 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 |
$798.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| 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 |
$781.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$336.00
|
| 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 |
$229.32
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 26111
|
| Hospital Charge Code |
6126111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: First Health Commercial |
$765.00
|
| Rate for Payer: First Health Workers Compensation |
$328.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.00
|
| Rate for Payer: GEHA Commercial |
$595.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.00
|
| Rate for Payer: Multiplan All |
$773.50
|
| Rate for Payer: OMNI Networks Commercial |
$595.00
|
| Rate for Payer: One Health Plan PPO/POS |
$765.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.50
|
| Rate for Payer: Three Rivers Provider Network All |
$637.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.50
|
| Rate for Payer: Zelis Auto |
$340.00
|
| Rate for Payer: Zelis Worker's Compensation |
$232.05
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 26111
|
| Hospital Charge Code |
6126111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$510.00
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: First Health Commercial |
$765.00
|
| Rate for Payer: First Health Workers Compensation |
$328.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.00
|
| Rate for Payer: GEHA Commercial |
$680.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.00
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$773.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$595.00
|
| Rate for Payer: One Health Plan PPO/POS |
$765.00
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$637.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$340.00
|
| 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 |
$232.05
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 26116
|
| Hospital Charge Code |
6126116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.11 |
| 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 |
$642.00
|
| 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 |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: First Health Workers Compensation |
$413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$856.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| 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 |
$1,016.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| 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 |
$995.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$428.00
|
| 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 |
$292.11
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 26116
|
| Hospital Charge Code |
6126116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.11 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: First Health Workers Compensation |
$413.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$749.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,016.50
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$995.10
|
| Rate for Payer: Zelis Auto |
$428.00
|
| Rate for Payer: Zelis Worker's Compensation |
$292.11
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 26113
|
| Hospital Charge Code |
6126113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.12 |
| Max. Negotiated Rate |
$1,058.30 |
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cigna Commercial |
$946.90
|
| Rate for Payer: First Health Commercial |
$1,002.60
|
| Rate for Payer: First Health Workers Compensation |
$430.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,002.60
|
| Rate for Payer: GEHA Commercial |
$779.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,002.60
|
| Rate for Payer: Multiplan All |
$1,013.74
|
| Rate for Payer: OMNI Networks Commercial |
$779.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,002.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,058.30
|
| Rate for Payer: Three Rivers Provider Network All |
$835.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.02
|
| Rate for Payer: Zelis Auto |
$445.60
|
| Rate for Payer: Zelis Worker's Compensation |
$304.12
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 26113
|
| Hospital Charge Code |
6126113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.12 |
| Max. Negotiated Rate |
$3,076.96 |
| 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 |
$668.40
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cigna Commercial |
$946.90
|
| Rate for Payer: First Health Commercial |
$1,002.60
|
| Rate for Payer: First Health Workers Compensation |
$430.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,002.60
|
| Rate for Payer: GEHA Commercial |
$891.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,002.60
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,013.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$779.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,002.60
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,058.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$835.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$445.60
|
| 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 |
$304.12
|
|
|
EXC HAND TUM RA < 3 CM
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 26117
|
| Hospital Charge Code |
6126117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.42 |
| Max. Negotiated Rate |
$1,452.55 |
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$1,299.65
|
| Rate for Payer: First Health Commercial |
$1,376.10
|
| Rate for Payer: First Health Workers Compensation |
$590.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,376.10
|
| Rate for Payer: GEHA Commercial |
$1,070.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,376.10
|
| Rate for Payer: Multiplan All |
$1,391.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,070.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,376.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,452.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,146.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,421.97
|
| Rate for Payer: Zelis Auto |
$611.60
|
| Rate for Payer: Zelis Worker's Compensation |
$417.42
|
|
|
EXC HAND TUM RA < 3 CM
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 26117
|
| Hospital Charge Code |
6126117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.42 |
| 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 |
$917.40
|
| 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 |
$917.40
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$1,299.65
|
| Rate for Payer: First Health Commercial |
$1,376.10
|
| Rate for Payer: First Health Workers Compensation |
$590.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,376.10
|
| Rate for Payer: GEHA Commercial |
$1,223.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,376.10
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,391.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,070.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,376.10
|
| 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 |
$1,452.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,146.75
|
| 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 |
$1,421.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$611.60
|
| 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 |
$417.42
|
|
|
EXC HAND TUM RA 3 CM/>
|
Facility
|
OP
|
$2,153.00
|
|
|
Service Code
|
CPT 26118
|
| Hospital Charge Code |
6126118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$587.77 |
| 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 |
$1,291.80
|
| 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 |
$1,291.80
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$1,830.05
|
| Rate for Payer: First Health Commercial |
$1,937.70
|
| Rate for Payer: First Health Workers Compensation |
$831.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,937.70
|
| Rate for Payer: GEHA Commercial |
$1,722.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,937.70
|
| 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 |
$1,959.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,507.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,937.70
|
| 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 |
$2,045.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,614.75
|
| 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 |
$2,002.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$861.20
|
| 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 |
$587.77
|
|
|
EXC HAND TUM RA 3 CM/>
|
Facility
|
IP
|
$2,153.00
|
|
|
Service Code
|
CPT 26118
|
| Hospital Charge Code |
6126118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$587.77 |
| Max. Negotiated Rate |
$2,045.35 |
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$1,830.05
|
| Rate for Payer: First Health Commercial |
$1,937.70
|
| Rate for Payer: First Health Workers Compensation |
$831.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,937.70
|
| Rate for Payer: GEHA Commercial |
$1,507.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,937.70
|
| Rate for Payer: Multiplan All |
$1,959.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,507.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,937.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,045.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,614.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,002.29
|
| Rate for Payer: Zelis Auto |
$861.20
|
| Rate for Payer: Zelis Worker's Compensation |
$587.77
|
|
|
EXCHANGE DRAINAGE CATHETER
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
6149423
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$87.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Worker's Compensation |
$61.70
|
|
|
EXCHANGE DRAINAGE CATHETER
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
6149423
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,226.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$87.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,251.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,444.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,251.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$61.70
|
|
|
EXC H-F-NK-SP MLG+MARG 0.5 <
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
6111620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.46 |
| 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 |
$220.80
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$294.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| 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 |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| 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 |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| 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 |
$342.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$147.20
|
| 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 |
$100.46
|
|
|
EXC H-F-NK-SP MLG+MARG 0.5 <
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
6111620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
EXC H-F-NK-SP MLG+MARG 0.5<
|
Facility
|
OP
|
$6,212.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
20311620
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$5,901.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,727.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,727.20
|
| Rate for Payer: Cash Price |
$3,727.20
|
| Rate for Payer: Cigna Commercial |
$5,280.20
|
| Rate for Payer: First Health Commercial |
$5,590.80
|
| Rate for Payer: First Health Workers Compensation |
$2,398.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,590.80
|
| Rate for Payer: GEHA Commercial |
$4,969.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,590.80
|
| 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 |
$5,652.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,348.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,590.80
|
| 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 |
$5,901.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$4,659.00
|
| 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 |
$5,777.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,484.80
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,695.88
|
|
