|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
20300106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.46 |
| Max. Negotiated Rate |
$979.45 |
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$876.35
|
| Rate for Payer: First Health Commercial |
$927.90
|
| Rate for Payer: First Health Workers Compensation |
$398.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$927.90
|
| Rate for Payer: GEHA Commercial |
$721.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$927.90
|
| Rate for Payer: Multiplan All |
$938.21
|
| Rate for Payer: OMNI Networks Commercial |
$721.70
|
| Rate for Payer: One Health Plan PPO/POS |
$927.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$979.45
|
| Rate for Payer: Three Rivers Provider Network All |
$773.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$958.83
|
| Rate for Payer: Zelis Auto |
$412.40
|
| Rate for Payer: Zelis Worker's Compensation |
$281.46
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9400024
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$281.46 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$618.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$876.35
|
| Rate for Payer: First Health Commercial |
$927.90
|
| Rate for Payer: First Health Workers Compensation |
$398.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$927.90
|
| Rate for Payer: GEHA Commercial |
$824.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$927.90
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$938.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$721.70
|
| Rate for Payer: One Health Plan PPO/POS |
$927.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$979.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$773.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$958.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$412.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$281.46
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9400024
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$281.46 |
| Max. Negotiated Rate |
$979.45 |
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$876.35
|
| Rate for Payer: First Health Commercial |
$927.90
|
| Rate for Payer: First Health Workers Compensation |
$398.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$927.90
|
| Rate for Payer: GEHA Commercial |
$721.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$927.90
|
| Rate for Payer: Multiplan All |
$938.21
|
| Rate for Payer: OMNI Networks Commercial |
$721.70
|
| Rate for Payer: One Health Plan PPO/POS |
$927.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$979.45
|
| Rate for Payer: Three Rivers Provider Network All |
$773.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$958.83
|
| Rate for Payer: Zelis Auto |
$412.40
|
| Rate for Payer: Zelis Worker's Compensation |
$281.46
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
6111426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$691.20
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
IP
|
$929.61
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
8511426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cigna Commercial |
$790.17
|
| Rate for Payer: First Health Commercial |
$836.65
|
| Rate for Payer: First Health Workers Compensation |
$358.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.65
|
| Rate for Payer: GEHA Commercial |
$650.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.65
|
| Rate for Payer: Multiplan All |
$845.95
|
| Rate for Payer: OMNI Networks Commercial |
$650.73
|
| Rate for Payer: One Health Plan PPO/POS |
$836.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$883.13
|
| Rate for Payer: Three Rivers Provider Network All |
$697.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$864.54
|
| Rate for Payer: Zelis Auto |
$371.84
|
| Rate for Payer: Zelis Worker's Compensation |
$253.78
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
OP
|
$929.61
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
8511426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$557.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cigna Commercial |
$790.17
|
| Rate for Payer: First Health Commercial |
$836.65
|
| Rate for Payer: First Health Workers Compensation |
$358.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.65
|
| Rate for Payer: GEHA Commercial |
$743.69
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.65
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$845.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$650.73
|
| Rate for Payer: One Health Plan PPO/POS |
$836.65
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$883.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$697.21
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$864.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$371.84
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$253.78
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
OP
|
$929.61
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
7211426
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$557.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cigna Commercial |
$790.17
|
| Rate for Payer: First Health Commercial |
$836.65
|
| Rate for Payer: First Health Workers Compensation |
$358.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.65
|
| Rate for Payer: GEHA Commercial |
$743.69
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.65
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$845.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$650.73
|
| Rate for Payer: One Health Plan PPO/POS |
$836.65
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$883.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$697.21
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$864.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$371.84
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$253.78
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
6111426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
20300106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.46 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$618.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$876.35
|
| Rate for Payer: First Health Commercial |
$927.90
|
| Rate for Payer: First Health Workers Compensation |
$398.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$927.90
|
| Rate for Payer: GEHA Commercial |
$824.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$927.90
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$938.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$721.70
|
| Rate for Payer: One Health Plan PPO/POS |
$927.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$979.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$773.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$958.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$412.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$281.46
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
OP
|
$8,182.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
1911426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,873.34 |
| Max. Negotiated Rate |
$7,772.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,909.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$4,909.20
|
| Rate for Payer: Cash Price |
$4,909.20
|
| Rate for Payer: Cigna Commercial |
$6,954.70
|
| Rate for Payer: First Health Commercial |
$7,363.80
|
| Rate for Payer: First Health Workers Compensation |
$3,159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,363.80
|
| Rate for Payer: GEHA Commercial |
$6,545.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,363.80
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$7,445.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$5,727.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,363.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,772.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$6,136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,609.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$3,272.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,233.69
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
IP
|
$8,182.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
1911426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,233.69 |
| Max. Negotiated Rate |
$7,772.90 |
| Rate for Payer: Cash Price |
$4,909.20
|
| Rate for Payer: Cigna Commercial |
$6,954.70
|
| Rate for Payer: First Health Commercial |
$7,363.80
|
| Rate for Payer: First Health Workers Compensation |
$3,159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,363.80
|
| Rate for Payer: GEHA Commercial |
$5,727.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,363.80
|
| Rate for Payer: Multiplan All |
$7,445.62
|
| Rate for Payer: OMNI Networks Commercial |
$5,727.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,363.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,772.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,609.26
|
| Rate for Payer: Zelis Auto |
$3,272.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,233.69
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G >4CM
|
Facility
|
IP
|
$929.61
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
7211426
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cigna Commercial |
$790.17
|
| Rate for Payer: First Health Commercial |
$836.65
|
| Rate for Payer: First Health Workers Compensation |
$358.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.65
|
| Rate for Payer: GEHA Commercial |
$650.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.65
|
| Rate for Payer: Multiplan All |
$845.95
|
| Rate for Payer: OMNI Networks Commercial |
$650.73
|
| Rate for Payer: One Health Plan PPO/POS |
$836.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$883.13
|
| Rate for Payer: Three Rivers Provider Network All |
$697.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$864.54
|
| Rate for Payer: Zelis Auto |
$371.84
|
| Rate for Payer: Zelis Worker's Compensation |
$253.78
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9400019
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9400019
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
OP
|
$347.10
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
7211420
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$208.26
|
| Rate for Payer: Cash Price |
$208.26
|
| Rate for Payer: Cigna Commercial |
$295.04
|
| Rate for Payer: First Health Commercial |
$312.39
|
| Rate for Payer: First Health Workers Compensation |
$134.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.39
|
| Rate for Payer: GEHA Commercial |
$277.68
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.39
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$315.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$242.97
|
| Rate for Payer: One Health Plan PPO/POS |
$312.39
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$260.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$138.84
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$94.76
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8811420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
IP
|
$347.10
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
7211420
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$329.75 |
| Rate for Payer: Cash Price |
$208.26
|
| Rate for Payer: Cigna Commercial |
$295.04
|
| Rate for Payer: First Health Commercial |
$312.39
|
| Rate for Payer: First Health Workers Compensation |
$134.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.39
|
| Rate for Payer: GEHA Commercial |
$242.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.39
|
| Rate for Payer: Multiplan All |
$315.86
|
| Rate for Payer: OMNI Networks Commercial |
$242.97
|
| Rate for Payer: One Health Plan PPO/POS |
$312.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.75
|
| Rate for Payer: Three Rivers Provider Network All |
$260.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.80
|
| Rate for Payer: Zelis Auto |
$138.84
|
| Rate for Payer: Zelis Worker's Compensation |
$94.76
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
OP
|
$347.10
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8511420
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$208.26
|
| Rate for Payer: Cash Price |
$208.26
|
| Rate for Payer: Cigna Commercial |
$295.04
|
| Rate for Payer: First Health Commercial |
$312.39
|
| Rate for Payer: First Health Workers Compensation |
$134.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.39
|
| Rate for Payer: GEHA Commercial |
$277.68
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.39
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$315.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$242.97
|
| Rate for Payer: One Health Plan PPO/POS |
$312.39
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$260.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$138.84
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$94.76
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
IP
|
$347.10
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8511420
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$329.75 |
| Rate for Payer: Cash Price |
$208.26
|
| Rate for Payer: Cigna Commercial |
$295.04
|
| Rate for Payer: First Health Commercial |
$312.39
|
| Rate for Payer: First Health Workers Compensation |
$134.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$312.39
|
| Rate for Payer: GEHA Commercial |
$242.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$312.39
|
| Rate for Payer: Multiplan All |
$315.86
|
| Rate for Payer: OMNI Networks Commercial |
$242.97
|
| Rate for Payer: One Health Plan PPO/POS |
$312.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$329.75
|
| Rate for Payer: Three Rivers Provider Network All |
$260.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$322.80
|
| Rate for Payer: Zelis Auto |
$138.84
|
| Rate for Payer: Zelis Worker's Compensation |
$94.76
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
6111420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8811420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8211420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8211420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .5/<
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
6111420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9400020
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
