|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9400020
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$284.40
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$284.40
|
| 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 |
$379.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
OP
|
$438.39
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
6111421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$263.03
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cigna Commercial |
$372.63
|
| Rate for Payer: First Health Commercial |
$394.55
|
| Rate for Payer: First Health Workers Compensation |
$169.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.55
|
| Rate for Payer: GEHA Commercial |
$350.71
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.55
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$398.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$306.87
|
| Rate for Payer: One Health Plan PPO/POS |
$394.55
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.47
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$328.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$175.36
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$119.68
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
OP
|
$438.39
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
8511421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$1,336.18 |
| 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 |
$263.03
|
| 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 |
$668.09
|
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cigna Commercial |
$372.63
|
| Rate for Payer: First Health Commercial |
$394.55
|
| Rate for Payer: First Health Workers Compensation |
$169.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.55
|
| Rate for Payer: GEHA Commercial |
$350.71
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.55
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$398.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$306.87
|
| Rate for Payer: One Health Plan PPO/POS |
$394.55
|
| 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 |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.47
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$328.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$175.36
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$119.68
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
IP
|
$438.39
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
6111421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cigna Commercial |
$372.63
|
| Rate for Payer: First Health Commercial |
$394.55
|
| Rate for Payer: First Health Workers Compensation |
$169.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.55
|
| Rate for Payer: GEHA Commercial |
$306.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.55
|
| Rate for Payer: Multiplan All |
$398.93
|
| Rate for Payer: OMNI Networks Commercial |
$306.87
|
| Rate for Payer: One Health Plan PPO/POS |
$394.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.47
|
| Rate for Payer: Three Rivers Provider Network All |
$328.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.70
|
| Rate for Payer: Zelis Auto |
$175.36
|
| Rate for Payer: Zelis Worker's Compensation |
$119.68
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
IP
|
$438.39
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
8511421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cigna Commercial |
$372.63
|
| Rate for Payer: First Health Commercial |
$394.55
|
| Rate for Payer: First Health Workers Compensation |
$169.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.55
|
| Rate for Payer: GEHA Commercial |
$306.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.55
|
| Rate for Payer: Multiplan All |
$398.93
|
| Rate for Payer: OMNI Networks Commercial |
$306.87
|
| Rate for Payer: One Health Plan PPO/POS |
$394.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.47
|
| Rate for Payer: Three Rivers Provider Network All |
$328.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.70
|
| Rate for Payer: Zelis Auto |
$175.36
|
| Rate for Payer: Zelis Worker's Compensation |
$119.68
|
|
|
EXC B9 LES MRGN XCP SK TG S/N/H/F/G .6-1
|
Facility
|
IP
|
$438.39
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
7211421
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Cash Price |
$263.03
|
| Rate for Payer: Cigna Commercial |
$372.63
|
| Rate for Payer: First Health Commercial |
$394.55
|
| Rate for Payer: First Health Workers Compensation |
$169.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.55
|
| Rate for Payer: GEHA Commercial |
$306.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.55
|
| Rate for Payer: Multiplan All |
$398.93
|
| Rate for Payer: OMNI Networks Commercial |
$306.87
|
| Rate for Payer: One Health Plan PPO/POS |
$394.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.47
|
| Rate for Payer: Three Rivers Provider Network All |
$328.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.70
|
| Rate for Payer: Zelis Auto |
$175.36
|
| Rate for Payer: Zelis Worker's Compensation |
$119.68
|
|
|
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
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$349.71
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
7211400
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$332.22 |
| Rate for Payer: Cash Price |
$209.83
|
| Rate for Payer: Cigna Commercial |
$297.25
|
| Rate for Payer: First Health Commercial |
$314.74
|
| Rate for Payer: First Health Workers Compensation |
$135.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.74
|
| Rate for Payer: GEHA Commercial |
$244.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.74
|
| Rate for Payer: Multiplan All |
$318.24
|
| Rate for Payer: OMNI Networks Commercial |
$244.80
|
| Rate for Payer: One Health Plan PPO/POS |
$314.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.22
|
| Rate for Payer: Three Rivers Provider Network All |
$262.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.23
|
| Rate for Payer: Zelis Auto |
$139.88
|
| Rate for Payer: Zelis Worker's Compensation |
$95.47
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$4,764.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
1911400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.43 |
| Max. Negotiated Rate |
$4,525.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,858.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cigna Commercial |
$4,049.40
|
| Rate for Payer: First Health Commercial |
$4,287.60
|
| Rate for Payer: First Health Workers Compensation |
$1,839.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,287.60
|
| Rate for Payer: GEHA Commercial |
$3,811.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,287.60
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$4,335.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,334.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,287.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,525.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$3,573.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,430.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,905.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$1,300.57
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
6111400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
20300107
|
|
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 T/A/L 0.5 CM/<
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
20300107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| 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 |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| 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 |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| 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 |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$349.71
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
8511400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$332.22 |
| Rate for Payer: Cash Price |
$209.83
|
| Rate for Payer: Cigna Commercial |
$297.25
|
| Rate for Payer: First Health Commercial |
$314.74
|
| Rate for Payer: First Health Workers Compensation |
$135.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.74
|
| Rate for Payer: GEHA Commercial |
$244.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.74
|
| Rate for Payer: Multiplan All |
$318.24
|
| Rate for Payer: OMNI Networks Commercial |
$244.80
|
| Rate for Payer: One Health Plan PPO/POS |
$314.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.22
|
| Rate for Payer: Three Rivers Provider Network All |
$262.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.23
|
| Rate for Payer: Zelis Auto |
$139.88
|
| Rate for Payer: Zelis Worker's Compensation |
$95.47
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$349.71
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
7211400
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$209.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$209.83
|
| Rate for Payer: Cash Price |
$209.83
|
| Rate for Payer: Cigna Commercial |
$297.25
|
| Rate for Payer: First Health Commercial |
$314.74
|
| Rate for Payer: First Health Workers Compensation |
$135.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.74
|
| Rate for Payer: GEHA Commercial |
$279.77
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.74
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$318.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$244.80
|
| Rate for Payer: One Health Plan PPO/POS |
$314.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$262.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$139.88
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$95.47
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$349.71
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
8511400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$209.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$209.83
|
| Rate for Payer: Cash Price |
$209.83
|
| Rate for Payer: Cigna Commercial |
$297.25
|
| Rate for Payer: First Health Commercial |
$314.74
|
| Rate for Payer: First Health Workers Compensation |
$135.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.74
|
| Rate for Payer: GEHA Commercial |
$279.77
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.74
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$318.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$244.80
|
| Rate for Payer: One Health Plan PPO/POS |
$314.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$262.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$139.88
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$95.47
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9400013
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| 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 |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| 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 |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| 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 |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$4,764.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
1911400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,300.57 |
| Max. Negotiated Rate |
$4,525.80 |
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cigna Commercial |
$4,049.40
|
| Rate for Payer: First Health Commercial |
$4,287.60
|
| Rate for Payer: First Health Workers Compensation |
$1,839.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,287.60
|
| Rate for Payer: GEHA Commercial |
$3,334.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,287.60
|
| Rate for Payer: Multiplan All |
$4,335.24
|
| Rate for Payer: OMNI Networks Commercial |
$3,334.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,287.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,525.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,573.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,430.52
|
| Rate for Payer: Zelis Auto |
$1,905.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,300.57
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
6111400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9400013
|
|
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 T/A/L 0.6-1 CM
|
Facility
|
IP
|
$2,859.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
1911401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.51 |
| Max. Negotiated Rate |
$2,716.05 |
| Rate for Payer: Cash Price |
$1,715.40
|
| Rate for Payer: Cigna Commercial |
$2,430.15
|
| Rate for Payer: First Health Commercial |
$2,573.10
|
| Rate for Payer: First Health Workers Compensation |
$1,103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,573.10
|
| Rate for Payer: GEHA Commercial |
$2,001.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,573.10
|
| Rate for Payer: Multiplan All |
$2,601.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,001.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,573.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,716.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,144.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,658.87
|
| Rate for Payer: Zelis Auto |
$1,143.60
|
| Rate for Payer: Zelis Worker's Compensation |
$780.51
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1 CM
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9400014
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$362.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1 CM
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
20300108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$430.35 |
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$317.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1 CM
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
6111401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1 CM
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9400014
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$430.35 |
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$385.05
|
| Rate for Payer: First Health Commercial |
$407.70
|
| Rate for Payer: First Health Workers Compensation |
$174.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$407.70
|
| Rate for Payer: GEHA Commercial |
$317.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$407.70
|
| Rate for Payer: Multiplan All |
$412.23
|
| Rate for Payer: OMNI Networks Commercial |
$317.10
|
| Rate for Payer: One Health Plan PPO/POS |
$407.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$430.35
|
| Rate for Payer: Three Rivers Provider Network All |
$339.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$421.29
|
| Rate for Payer: Zelis Auto |
$181.20
|
| Rate for Payer: Zelis Worker's Compensation |
$123.67
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1 CM
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
6111401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$256.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
