|
APPLY REM FIXATION DEVICE
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 20660
|
| Hospital Charge Code |
6120660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$252.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$457.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Worker's Compensation |
$178.54
|
|
|
APPLY R&L PULM ART BANDS
|
Facility
|
IP
|
$3,532.00
|
|
|
Service Code
|
CPT 33620
|
| Hospital Charge Code |
6133620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$964.24 |
| Max. Negotiated Rate |
$3,355.40 |
| Rate for Payer: Cash Price |
$2,119.20
|
| Rate for Payer: Cigna Commercial |
$3,002.20
|
| Rate for Payer: First Health Commercial |
$3,178.80
|
| Rate for Payer: First Health Workers Compensation |
$1,363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,178.80
|
| Rate for Payer: GEHA Commercial |
$2,472.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,178.80
|
| Rate for Payer: Multiplan All |
$3,214.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,472.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,178.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,355.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,649.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,284.76
|
| Rate for Payer: Zelis Auto |
$1,412.80
|
| Rate for Payer: Zelis Worker's Compensation |
$964.24
|
|
|
APPLY R&L PULM ART BANDS
|
Facility
|
OP
|
$3,532.00
|
|
|
Service Code
|
CPT 33620
|
| Hospital Charge Code |
6133620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$883.00 |
| Max. Negotiated Rate |
$3,355.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,119.20
|
| Rate for Payer: Cash Price |
$2,119.20
|
| Rate for Payer: Cigna Commercial |
$3,002.20
|
| Rate for Payer: First Health Commercial |
$3,178.80
|
| Rate for Payer: First Health Workers Compensation |
$1,363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,178.80
|
| Rate for Payer: GEHA Commercial |
$2,825.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,178.80
|
| Rate for Payer: Humana ChoiceCare |
$918.32
|
| Rate for Payer: Multiplan All |
$3,214.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,119.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,472.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,178.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,355.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,649.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,108.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$883.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,284.76
|
| Rate for Payer: Zelis Auto |
$1,412.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,766.00
|
| Rate for Payer: Zelis Worker's Compensation |
$964.24
|
|
|
APPLY SRS HEADFRAME ADD-ON
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 61800
|
| Hospital Charge Code |
6161800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$400.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Humana ChoiceCare |
$130.26
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$300.60
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$440.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$250.50
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
APPLY SRS HEADFRAME ADD-ON
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 61800
|
| Hospital Charge Code |
6161800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$350.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
APP SKN SUBGRFT TAL>/=100SCM ADL 100SQCM
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
20300122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$328.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$59.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$138.00
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$202.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$115.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
APP SKN SUBGRFT TAL>/=100SCM ADL 100SQCM
|
Facility
|
IP
|
$3,777.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
1905287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.12 |
| Max. Negotiated Rate |
$3,588.15 |
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Cigna Commercial |
$3,210.45
|
| Rate for Payer: First Health Commercial |
$3,399.30
|
| Rate for Payer: First Health Workers Compensation |
$1,458.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,399.30
|
| Rate for Payer: GEHA Commercial |
$2,643.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,399.30
|
| Rate for Payer: Multiplan All |
$3,437.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,643.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,399.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,588.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,832.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,512.61
|
| Rate for Payer: Zelis Auto |
$1,510.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,031.12
|
|
|
APP SKN SUBGRFT TAL>/=100SCM ADL 100SQCM
|
Facility
|
OP
|
$3,777.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
1905287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.61 |
| Max. Negotiated Rate |
$3,588.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,266.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Cigna Commercial |
$3,210.45
|
| Rate for Payer: First Health Commercial |
$3,399.30
|
| Rate for Payer: First Health Workers Compensation |
$1,458.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,399.30
|
| Rate for Payer: GEHA Commercial |
$3,021.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,399.30
|
| Rate for Payer: Humana ChoiceCare |
$982.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Multiplan All |
$3,437.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,266.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,643.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,399.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,588.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,832.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,323.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,512.61
|
| Rate for Payer: Zelis Auto |
$1,510.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,888.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,031.12
|
|
|
APP SKN SUBGRFT TAL>/=100SCM ADL 100SQCM
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
6115274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
APP SKN SUBGRFT TAL>/=100SCM ADL 100SQCM
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
6115274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$328.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$38.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$88.20
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$129.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.50
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
APP SKN SUBGRFT TAL>/=100SCM ADL 100SQCM
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
20300122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
APP SKN SUBGRFT TAL 100SQCM 1ST 100SQCM
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
6115273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: First Health Workers Compensation |
$248.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$450.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Worker's Compensation |
$175.81
|
|
|
APP SKN SUBGRFT TAL 100SQCM 1ST 100SQCM
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
20300121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$255.25 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: First Health Workers Compensation |
$361.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Worker's Compensation |
$255.25
|
|
|
APP SKN SUBGRFT TAL 100SQCM 1ST 100SQCM
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
6115273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$502.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$386.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$502.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$397.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: First Health Workers Compensation |
$248.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$405.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$468.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$405.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$405.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$175.81
|
|
|
APP SKN SUBGRFT TAL 100SQCM 1ST 100SQCM
|
Facility
|
IP
|
$6,125.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
1905286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,818.75 |
| Rate for Payer: Cash Price |
$3,675.00
|
| Rate for Payer: Cigna Commercial |
$5,206.25
|
| Rate for Payer: First Health Commercial |
$5,512.50
|
| Rate for Payer: First Health Workers Compensation |
$2,364.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,512.50
|
| Rate for Payer: GEHA Commercial |
$4,287.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,512.50
|
| Rate for Payer: Multiplan All |
$5,573.75
|
| Rate for Payer: OMNI Networks Commercial |
$4,287.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,512.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,818.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,593.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,696.25
|
| Rate for Payer: Zelis Auto |
$2,450.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,672.12
|
|
|
APP SKN SUBGRFT TAL 100SQCM 1ST 100SQCM
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
20300121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$255.25 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$502.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$502.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$397.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: First Health Workers Compensation |
$361.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$405.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$468.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$405.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$405.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$255.25
|
|
|
APP SKN SUBGRFT TAL 100SQCM 1ST 100SQCM
|
Facility
|
OP
|
$6,125.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
1905286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.69 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$502.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$502.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$397.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$3,675.00
|
| Rate for Payer: Cash Price |
$3,675.00
|
| Rate for Payer: Cigna Commercial |
$5,206.25
|
| Rate for Payer: First Health Commercial |
$5,512.50
|
| Rate for Payer: First Health Workers Compensation |
$2,364.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,512.50
|
| Rate for Payer: GEHA Commercial |
$4,900.00
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,512.50
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$405.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$5,573.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$4,287.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,512.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$468.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$405.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,818.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$4,593.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$405.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,696.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$2,450.00
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$1,672.12
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
IP
|
$4,351.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
1905284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,187.82 |
| Max. Negotiated Rate |
$4,133.45 |
| Rate for Payer: Cash Price |
$2,610.60
|
| Rate for Payer: Cigna Commercial |
$3,698.35
|
| Rate for Payer: First Health Commercial |
$3,915.90
|
| Rate for Payer: First Health Workers Compensation |
$1,679.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,915.90
|
| Rate for Payer: GEHA Commercial |
$3,045.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,915.90
|
| Rate for Payer: Multiplan All |
$3,959.41
|
| Rate for Payer: OMNI Networks Commercial |
$3,045.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,915.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,133.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,263.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,046.43
|
| Rate for Payer: Zelis Auto |
$1,740.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,187.82
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
OP
|
$4,287.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9615271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.61 |
| Max. Negotiated Rate |
$4,072.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,572.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cigna Commercial |
$3,643.95
|
| Rate for Payer: First Health Commercial |
$3,858.30
|
| Rate for Payer: First Health Workers Compensation |
$1,655.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,858.30
|
| Rate for Payer: GEHA Commercial |
$3,429.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,858.30
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$3,901.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,000.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,858.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,072.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$3,215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,986.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,714.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,170.35
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
20300119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
IP
|
$4,287.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9615271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,170.35 |
| Max. Negotiated Rate |
$4,072.65 |
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cigna Commercial |
$3,643.95
|
| Rate for Payer: First Health Commercial |
$3,858.30
|
| Rate for Payer: First Health Workers Compensation |
$1,655.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,858.30
|
| Rate for Payer: GEHA Commercial |
$3,000.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,858.30
|
| Rate for Payer: Multiplan All |
$3,901.17
|
| Rate for Payer: OMNI Networks Commercial |
$3,000.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,858.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,072.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,986.91
|
| Rate for Payer: Zelis Auto |
$1,714.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,170.35
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
OP
|
$4,351.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
1905284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.61 |
| Max. Negotiated Rate |
$4,133.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,610.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$2,610.60
|
| Rate for Payer: Cash Price |
$2,610.60
|
| Rate for Payer: Cigna Commercial |
$3,698.35
|
| Rate for Payer: First Health Commercial |
$3,915.90
|
| Rate for Payer: First Health Workers Compensation |
$1,679.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,915.90
|
| Rate for Payer: GEHA Commercial |
$3,480.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,915.90
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$3,959.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,045.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,915.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,133.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$3,263.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,046.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,740.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,187.82
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
IP
|
$439.41
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
6115271
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.96 |
| Max. Negotiated Rate |
$417.44 |
| Rate for Payer: Cash Price |
$263.65
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$395.47
|
| Rate for Payer: First Health Workers Compensation |
$169.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.47
|
| Rate for Payer: GEHA Commercial |
$307.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.47
|
| Rate for Payer: Multiplan All |
$399.86
|
| Rate for Payer: OMNI Networks Commercial |
$307.59
|
| Rate for Payer: One Health Plan PPO/POS |
$395.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.44
|
| Rate for Payer: Three Rivers Provider Network All |
$329.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.65
|
| Rate for Payer: Zelis Auto |
$175.76
|
| Rate for Payer: Zelis Worker's Compensation |
$119.96
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
20300119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$350.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
APP SKN SUB GRFT TAL 100SQ CM/<1ST 25
|
Facility
|
OP
|
$439.41
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
6115271
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.96 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$263.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$328.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$260.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$263.65
|
| Rate for Payer: Cash Price |
$263.65
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$395.47
|
| Rate for Payer: First Health Workers Compensation |
$169.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.47
|
| Rate for Payer: GEHA Commercial |
$351.53
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.47
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$265.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$399.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$307.59
|
| Rate for Payer: One Health Plan PPO/POS |
$395.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$307.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$265.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$329.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$175.76
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$119.96
|
|
