|
ER DIRECT ADMIT TO OBSERVATION
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
8110084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.83 |
| Max. Negotiated Rate |
$1,164.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$582.16
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$455.20
|
| Rate for Payer: GEHA Medicare |
$582.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$640.38
|
| Rate for Payer: Humana Medicare Advantage |
$582.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$978.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$70.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$582.16
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$989.67
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$81.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$70.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$582.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,164.32
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$570.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$582.16
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Medicare |
$494.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.59
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
ER DIRECT ADMIT TO OBSERVATION
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
8110084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
ERGOCALCIFEROL 1.25 MG CAP
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
3300305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
ERGOCALCIFEROL 1.25 MG CAP
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
3300305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
ER OBSERVATION EACH ADDL HOUR
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
8110083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.61
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Humana ChoiceCare |
$10.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.29
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.60
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
ER OBSERVATION EACH ADDL HOUR
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
8110083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
ER OBSERVATION INITIAL HOUR
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
8110082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
ER OBSERVATION INITIAL HOUR
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
8110082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.61
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$87.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.29
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.00
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$294.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$167.50
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
ERTAPENEM SODIUM 1GM VIAL
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
3300306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$10.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Humana ChoiceCare |
$144.56
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$333.60
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$489.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.00
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
ERTAPENEM SODIUM 1GM VIAL
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
3300306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$389.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
ER VISIT CRITICAL CARE FACILITY
|
Facility
|
IP
|
$3,737.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8199303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,020.20 |
| Max. Negotiated Rate |
$3,550.15 |
| Rate for Payer: Cash Price |
$2,242.20
|
| Rate for Payer: Cigna Commercial |
$3,176.45
|
| Rate for Payer: First Health Commercial |
$3,363.30
|
| Rate for Payer: First Health Workers Compensation |
$1,442.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,363.30
|
| Rate for Payer: GEHA Commercial |
$2,615.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,363.30
|
| Rate for Payer: Multiplan All |
$3,400.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,615.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,363.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,550.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,802.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,475.41
|
| Rate for Payer: Zelis Auto |
$1,494.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,020.20
|
|
|
ER VISIT CRITICAL CARE FACILITY
|
Facility
|
OP
|
$3,737.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8199303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.66 |
| Max. Negotiated Rate |
$3,550.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,242.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$588.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$800.09
|
| Rate for Payer: Cash Price |
$2,242.20
|
| Rate for Payer: Cash Price |
$2,242.20
|
| Rate for Payer: Cigna Commercial |
$3,176.45
|
| Rate for Payer: First Health Commercial |
$3,363.30
|
| Rate for Payer: First Health Workers Compensation |
$1,442.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,363.30
|
| Rate for Payer: GEHA Commercial |
$2,989.60
|
| Rate for Payer: GEHA Medicare |
$800.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,363.30
|
| Rate for Payer: Humana ChoiceCare |
$880.10
|
| Rate for Payer: Humana Medicare Advantage |
$800.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,344.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$600.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$800.09
|
| Rate for Payer: Multiplan All |
$3,400.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,615.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,363.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$693.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$600.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$800.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,550.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,600.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,802.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,475.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$800.09
|
| Rate for Payer: Zelis Auto |
$1,494.80
|
| Rate for Payer: Zelis Medicare |
$680.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$960.11
|
| Rate for Payer: Zelis Worker's Compensation |
$1,020.20
|
|
|
ER VISIT CRITICAL CARE FACILITY W/MOD 25
|
Facility
|
OP
|
$3,737.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8199314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.66 |
| Max. Negotiated Rate |
$3,550.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,242.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$588.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$800.09
|
| Rate for Payer: Cash Price |
$2,242.20
|
| Rate for Payer: Cash Price |
$2,242.20
|
| Rate for Payer: Cigna Commercial |
$3,176.45
|
| Rate for Payer: First Health Commercial |
$3,363.30
|
| Rate for Payer: First Health Workers Compensation |
$1,442.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,363.30
|
| Rate for Payer: GEHA Commercial |
$2,989.60
|
| Rate for Payer: GEHA Medicare |
$800.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,363.30
|
| Rate for Payer: Humana ChoiceCare |
$880.10
|
| Rate for Payer: Humana Medicare Advantage |
$800.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,344.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$600.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$800.09
|
| Rate for Payer: Multiplan All |
$3,400.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,615.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,363.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$693.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$600.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$800.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,550.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,600.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,802.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,475.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$800.09
|
| Rate for Payer: Zelis Auto |
$1,494.80
|
| Rate for Payer: Zelis Medicare |
$680.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$960.11
|
| Rate for Payer: Zelis Worker's Compensation |
$1,020.20
|
|
|
ER VISIT CRITICAL CARE FACILITY W/MOD 25
|
Facility
|
IP
|
$3,737.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8199314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,020.20 |
| Max. Negotiated Rate |
$3,550.15 |
| Rate for Payer: Cash Price |
$2,242.20
|
| Rate for Payer: Cigna Commercial |
$3,176.45
|
| Rate for Payer: First Health Commercial |
$3,363.30
|
| Rate for Payer: First Health Workers Compensation |
$1,442.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,363.30
|
| Rate for Payer: GEHA Commercial |
$2,615.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,363.30
|
| Rate for Payer: Multiplan All |
$3,400.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,615.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,363.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,550.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,802.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,475.41
|
| Rate for Payer: Zelis Auto |
$1,494.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,020.20
|
|
|
ER VISIT LEVEL I FACILITY
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8199306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$64.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$74.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$64.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
ER VISIT LEVEL I FACILITY
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8199306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
ER VISIT LEVEL I FACILITY W/MOD 25
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8199309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
ER VISIT LEVEL I FACILITY W/MOD 25
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8199309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$64.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$74.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$64.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
ER VISIT LEVEL II FACILITY
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8199300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$443.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
ER VISIT LEVEL II FACILITY
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8199300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.39 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$380.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$150.37
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$507.20
|
| Rate for Payer: GEHA Medicare |
$150.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Humana ChoiceCare |
$165.41
|
| Rate for Payer: Humana Medicare Advantage |
$150.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$252.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$150.37
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$255.63
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$150.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$300.74
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$147.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$150.37
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Medicare |
$127.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.44
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
ER VISIT LEVEL II FACILITY W/MOD 25
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8199310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$443.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
ER VISIT LEVEL II FACILITY W/MOD 25
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8199310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.39 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$380.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$150.37
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$244.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$507.20
|
| Rate for Payer: GEHA Medicare |
$150.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Humana ChoiceCare |
$165.41
|
| Rate for Payer: Humana Medicare Advantage |
$150.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$252.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$150.37
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$255.63
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$150.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$300.74
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$147.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$150.37
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Medicare |
$127.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.44
|
| Rate for Payer: Zelis Worker's Compensation |
$173.08
|
|
|
ER VISIT LEVEL III FACILITY
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8199301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.17 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$446.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Worker's Compensation |
$174.17
|
|
|
ER VISIT LEVEL III FACILITY
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8199301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.58 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$166.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$262.92
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$510.40
|
| Rate for Payer: GEHA Medicare |
$262.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Humana ChoiceCare |
$289.21
|
| Rate for Payer: Humana Medicare Advantage |
$262.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$441.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$169.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$262.92
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$446.96
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$196.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$169.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$262.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$525.84
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.66
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$262.92
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Medicare |
$223.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$315.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.17
|
|
|
ER VISIT LEVEL III FACILITY W/MOD 25
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8199311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.58 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$166.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$262.92
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$510.40
|
| Rate for Payer: GEHA Medicare |
$262.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Humana ChoiceCare |
$289.21
|
| Rate for Payer: Humana Medicare Advantage |
$262.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$441.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$169.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$262.92
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$446.96
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$196.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$169.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$262.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$525.84
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.66
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$262.92
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Medicare |
$223.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$315.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.17
|
|
