|
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
|
|
|
ER VISIT LEVEL IV FACILITY
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8199305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.19 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$404.33
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: GEHA Medicare |
$404.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$444.76
|
| Rate for Payer: Humana Medicare Advantage |
$404.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$679.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$270.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$404.33
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$687.36
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$312.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$270.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$404.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$808.66
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$396.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$404.33
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Medicare |
$343.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$485.20
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
ER VISIT LEVEL IV FACILITY
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8199305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.82 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
ER VISIT LEVEL IV FACILITY W/MOD 25
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8199312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.82 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
ER VISIT LEVEL IV FACILITY W/MOD 25
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8199312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.19 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$404.33
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: GEHA Medicare |
$404.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$444.76
|
| Rate for Payer: Humana Medicare Advantage |
$404.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$679.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$270.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$404.33
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$687.36
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$312.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$270.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$404.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$808.66
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$396.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$404.33
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Medicare |
$343.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$485.20
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
ER VISIT LEVEL V FACILITY
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8199302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.82 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,428.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$391.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$582.16
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,023.00
|
| Rate for Payer: First Health Commercial |
$2,142.00
|
| Rate for Payer: First Health Workers Compensation |
$918.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,142.00
|
| Rate for Payer: GEHA Commercial |
$1,904.00
|
| Rate for Payer: GEHA Medicare |
$582.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,142.00
|
| 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 |
$399.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$582.16
|
| Rate for Payer: Multiplan All |
$2,165.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$989.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,666.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,142.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$461.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$399.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$582.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,261.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,164.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,785.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$570.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$399.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,213.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$582.16
|
| Rate for Payer: Zelis Auto |
$952.00
|
| Rate for Payer: Zelis Medicare |
$494.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.59
|
| Rate for Payer: Zelis Worker's Compensation |
$649.74
|
|
|
ER VISIT LEVEL V FACILITY
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8199302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,023.00
|
| Rate for Payer: First Health Commercial |
$2,142.00
|
| Rate for Payer: First Health Workers Compensation |
$918.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,142.00
|
| Rate for Payer: GEHA Commercial |
$1,666.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,142.00
|
| Rate for Payer: Multiplan All |
$2,165.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,666.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,142.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,261.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,785.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,213.40
|
| Rate for Payer: Zelis Auto |
$952.00
|
| Rate for Payer: Zelis Worker's Compensation |
$649.74
|
|
|
ER VISIT LEVEL V FACILITY W/MOD 25
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8199313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.82 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,428.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$391.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$582.16
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,023.00
|
| Rate for Payer: First Health Commercial |
$2,142.00
|
| Rate for Payer: First Health Workers Compensation |
$918.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,142.00
|
| Rate for Payer: GEHA Commercial |
$1,904.00
|
| Rate for Payer: GEHA Medicare |
$582.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,142.00
|
| 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 |
$399.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$582.16
|
| Rate for Payer: Multiplan All |
$2,165.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$989.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,666.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,142.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$461.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$399.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$582.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,261.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,164.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,785.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$570.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$399.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,213.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$582.16
|
| Rate for Payer: Zelis Auto |
$952.00
|
| Rate for Payer: Zelis Medicare |
$494.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.59
|
| Rate for Payer: Zelis Worker's Compensation |
$649.74
|
|
|
ER VISIT LEVEL V FACILITY W/MOD 25
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8199313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,023.00
|
| Rate for Payer: First Health Commercial |
$2,142.00
|
| Rate for Payer: First Health Workers Compensation |
$918.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,142.00
|
| Rate for Payer: GEHA Commercial |
$1,666.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,142.00
|
| Rate for Payer: Multiplan All |
$2,165.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,666.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,142.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,261.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,785.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,213.40
|
| Rate for Payer: Zelis Auto |
$952.00
|
| Rate for Payer: Zelis Worker's Compensation |
$649.74
|
|
|
ERYTHROMYCIN LACTOBIONATE FOR INJ 500MG
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT J1364
|
| Hospital Charge Code |
3300307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.31 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$76.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$76.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$60.31
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$71.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Humana ChoiceCare |
$60.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$61.53
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$140.40
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$61.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$205.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$61.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.00
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
ERYTHROMYCIN LACTOBIONATE FOR INJ 500MG
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT J1364
|
| Hospital Charge Code |
3300307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
ERYTHROMYCIN OPTHALMIC OINT 1 GM
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
3303222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$53.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Humana ChoiceCare |
$17.42
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.20
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$58.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.50
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
ERYTHROMYCIN OPTHALMIC OINT 1 GM
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
3303222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$56.95
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: First Health Workers Compensation |
$25.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$60.30
|
| Rate for Payer: GEHA Commercial |
$46.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$60.30
|
| Rate for Payer: Multiplan All |
$60.97
|
| Rate for Payer: OMNI Networks Commercial |
$46.90
|
| Rate for Payer: One Health Plan PPO/POS |
$60.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$63.65
|
| Rate for Payer: Three Rivers Provider Network All |
$50.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$62.31
|
| Rate for Payer: Zelis Auto |
$26.80
|
| Rate for Payer: Zelis Worker's Compensation |
$18.29
|
|
|
ERYTHROMYCIN OPTHALMIC OINT 3.5 GM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
3300308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
ERYTHROMYCIN OPTHALMIC OINT 3.5 GM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
3300308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$43.16
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.60
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
ERYTHROMYCIN TAB 250MG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 24338012213
|
| Hospital Charge Code |
3300309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
ERYTHROMYCIN TAB 250MG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 24338012213
|
| Hospital Charge Code |
3300309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
erythropoietin (epo) REF140277
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
2299610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$33.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$141.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.91
|
|
|
erythropoietin (epo) REF140277
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
2299610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$33.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$161.60
|
| Rate for Payer: GEHA Medicare |
$18.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Humana ChoiceCare |
$20.67
|
| Rate for Payer: Humana Medicare Advantage |
$18.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.79
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.94
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.58
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.41
|
| Rate for Payer: United Healthcare Commercial |
$171.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.79
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Medicare |
$15.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.55
|
| Rate for Payer: Zelis Worker's Compensation |
$23.91
|
|
|
ESBL
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
2299072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$10.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$126.40
|
| Rate for Payer: GEHA Medicare |
$7.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Humana ChoiceCare |
$8.23
|
| Rate for Payer: Humana Medicare Advantage |
$7.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.48
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.72
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14.96
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.33
|
| Rate for Payer: United Healthcare Commercial |
$134.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.48
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Medicare |
$6.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.98
|
| Rate for Payer: Zelis Worker's Compensation |
$7.76
|
|
|
ESBL
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
2299072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$10.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$110.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Worker's Compensation |
$7.76
|
|
|
ESCHAROTOMY ADDL INCISION
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 16036
|
| Hospital Charge Code |
6116036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
ESCHAROTOMY ADDL INCISION
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 16036
|
| Hospital Charge Code |
6116036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
ESI CERVICAL/THORACI
|
Facility
|
OP
|
$1,915.00
|
|
| Hospital Charge Code |
2407214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.75 |
| Max. Negotiated Rate |
$1,819.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,149.00
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$1,627.75
|
| Rate for Payer: First Health Commercial |
$1,723.50
|
| Rate for Payer: First Health Workers Compensation |
$739.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,723.50
|
| Rate for Payer: GEHA Commercial |
$1,532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,723.50
|
| Rate for Payer: Humana ChoiceCare |
$497.90
|
| Rate for Payer: Multiplan All |
$1,742.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,149.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,340.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,723.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,819.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,436.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,685.20
|
| Rate for Payer: United Healthcare Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$478.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,780.95
|
| Rate for Payer: Zelis Auto |
$766.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$957.50
|
| Rate for Payer: Zelis Worker's Compensation |
$522.79
|
|
|
ESI CERVICAL/THORACI
|
Facility
|
IP
|
$1,915.00
|
|
| Hospital Charge Code |
2407214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$522.79 |
| Max. Negotiated Rate |
$1,819.25 |
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$1,627.75
|
| Rate for Payer: First Health Commercial |
$1,723.50
|
| Rate for Payer: First Health Workers Compensation |
$739.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,723.50
|
| Rate for Payer: GEHA Commercial |
$1,340.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,723.50
|
| Rate for Payer: Multiplan All |
$1,742.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,340.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,723.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,819.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,436.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,780.95
|
| Rate for Payer: Zelis Auto |
$766.00
|
| Rate for Payer: Zelis Worker's Compensation |
$522.79
|
|
