|
EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3 CM
|
Facility
|
OP
|
$4,816.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
1911403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$4,575.20 |
| 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 |
$2,889.60
|
| 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 |
$2,889.60
|
| Rate for Payer: Cash Price |
$2,889.60
|
| Rate for Payer: Cigna Commercial |
$4,093.60
|
| Rate for Payer: First Health Commercial |
$4,334.40
|
| Rate for Payer: First Health Workers Compensation |
$1,859.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,334.40
|
| Rate for Payer: GEHA Commercial |
$3,852.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,334.40
|
| 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 |
$4,382.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,371.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,334.40
|
| 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 |
$4,575.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$3,612.00
|
| 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 |
$4,478.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,926.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$1,314.77
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3 CM
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
9400016
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3 CM
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
20300109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3 CM
|
Facility
|
IP
|
$4,816.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
1911403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,314.77 |
| Max. Negotiated Rate |
$4,575.20 |
| Rate for Payer: Cash Price |
$2,889.60
|
| Rate for Payer: Cigna Commercial |
$4,093.60
|
| Rate for Payer: First Health Commercial |
$4,334.40
|
| Rate for Payer: First Health Workers Compensation |
$1,859.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,334.40
|
| Rate for Payer: GEHA Commercial |
$3,371.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,334.40
|
| Rate for Payer: Multiplan All |
$4,382.56
|
| Rate for Payer: OMNI Networks Commercial |
$3,371.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,334.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,575.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,612.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,478.88
|
| Rate for Payer: Zelis Auto |
$1,926.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,314.77
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3 CM
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
9400016
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$160.25 |
| 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 |
$352.20
|
| 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 |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$469.60
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| 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 |
$534.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| 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 |
$557.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| 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 |
$545.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
OP
|
$624.57
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
8511404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$374.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cigna Commercial |
$530.88
|
| Rate for Payer: First Health Commercial |
$562.11
|
| Rate for Payer: First Health Workers Compensation |
$241.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.11
|
| Rate for Payer: GEHA Commercial |
$499.66
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.11
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$568.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$437.20
|
| Rate for Payer: One Health Plan PPO/POS |
$562.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.34
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$468.43
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$249.83
|
| 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 |
$170.51
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
6111404
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
9400017
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$566.10
|
| Rate for Payer: First Health Commercial |
$599.40
|
| Rate for Payer: First Health Workers Compensation |
$257.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$599.40
|
| Rate for Payer: GEHA Commercial |
$466.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$599.40
|
| Rate for Payer: Multiplan All |
$606.06
|
| Rate for Payer: OMNI Networks Commercial |
$466.20
|
| Rate for Payer: One Health Plan PPO/POS |
$599.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$632.70
|
| Rate for Payer: Three Rivers Provider Network All |
$499.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$619.38
|
| Rate for Payer: Zelis Auto |
$266.40
|
| Rate for Payer: Zelis Worker's Compensation |
$181.82
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
20300110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$566.10
|
| Rate for Payer: First Health Commercial |
$599.40
|
| Rate for Payer: First Health Workers Compensation |
$257.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$599.40
|
| Rate for Payer: GEHA Commercial |
$466.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$599.40
|
| Rate for Payer: Multiplan All |
$606.06
|
| Rate for Payer: OMNI Networks Commercial |
$466.20
|
| Rate for Payer: One Health Plan PPO/POS |
$599.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$632.70
|
| Rate for Payer: Three Rivers Provider Network All |
$499.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$619.38
|
| Rate for Payer: Zelis Auto |
$266.40
|
| Rate for Payer: Zelis Worker's Compensation |
$181.82
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
20300110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$566.10
|
| Rate for Payer: First Health Commercial |
$599.40
|
| Rate for Payer: First Health Workers Compensation |
$257.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$599.40
|
| Rate for Payer: GEHA Commercial |
$532.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$599.40
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$606.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$466.20
|
| Rate for Payer: One Health Plan PPO/POS |
$599.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$632.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$499.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$619.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$266.40
|
| 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 |
$181.82
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
1911404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,646.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$5,165.45
|
| Rate for Payer: First Health Commercial |
$5,469.30
|
| Rate for Payer: First Health Workers Compensation |
$2,346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,469.30
|
| Rate for Payer: GEHA Commercial |
$4,861.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,469.30
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$5,530.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,253.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,469.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,773.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$4,557.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,651.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,430.80
|
| 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 |
$1,659.02
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
IP
|
$624.57
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
8511404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$593.34 |
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cigna Commercial |
$530.88
|
| Rate for Payer: First Health Commercial |
$562.11
|
| Rate for Payer: First Health Workers Compensation |
$241.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.11
|
| Rate for Payer: GEHA Commercial |
$437.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.11
|
| Rate for Payer: Multiplan All |
$568.36
|
| Rate for Payer: OMNI Networks Commercial |
$437.20
|
| Rate for Payer: One Health Plan PPO/POS |
$562.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.34
|
| Rate for Payer: Three Rivers Provider Network All |
$468.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.85
|
| Rate for Payer: Zelis Auto |
$249.83
|
| Rate for Payer: Zelis Worker's Compensation |
$170.51
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
OP
|
$624.57
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
7211404
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$374.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cigna Commercial |
$530.88
|
| Rate for Payer: First Health Commercial |
$562.11
|
| Rate for Payer: First Health Workers Compensation |
$241.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.11
|
| Rate for Payer: GEHA Commercial |
$499.66
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.11
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$568.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$437.20
|
| Rate for Payer: One Health Plan PPO/POS |
$562.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.34
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$468.43
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$249.83
|
| 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 |
$170.51
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
9400017
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$566.10
|
| Rate for Payer: First Health Commercial |
$599.40
|
| Rate for Payer: First Health Workers Compensation |
$257.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$599.40
|
| Rate for Payer: GEHA Commercial |
$532.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$599.40
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$606.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$466.20
|
| Rate for Payer: One Health Plan PPO/POS |
$599.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$632.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$499.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$619.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$266.40
|
| 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 |
$181.82
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
6111404
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$201.60
|
| 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 |
$137.59
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
1911404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,659.02 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Cash Price |
$3,646.20
|
| Rate for Payer: Cigna Commercial |
$5,165.45
|
| Rate for Payer: First Health Commercial |
$5,469.30
|
| Rate for Payer: First Health Workers Compensation |
$2,346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,469.30
|
| Rate for Payer: GEHA Commercial |
$4,253.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,469.30
|
| Rate for Payer: Multiplan All |
$5,530.07
|
| Rate for Payer: OMNI Networks Commercial |
$4,253.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,469.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,773.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,557.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,651.61
|
| Rate for Payer: Zelis Auto |
$2,430.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,659.02
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4 CM
|
Facility
|
IP
|
$624.57
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
7211404
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$593.34 |
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cigna Commercial |
$530.88
|
| Rate for Payer: First Health Commercial |
$562.11
|
| Rate for Payer: First Health Workers Compensation |
$241.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.11
|
| Rate for Payer: GEHA Commercial |
$437.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.11
|
| Rate for Payer: Multiplan All |
$568.36
|
| Rate for Payer: OMNI Networks Commercial |
$437.20
|
| Rate for Payer: One Health Plan PPO/POS |
$562.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.34
|
| Rate for Payer: Three Rivers Provider Network All |
$468.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.85
|
| Rate for Payer: Zelis Auto |
$249.83
|
| Rate for Payer: Zelis Worker's Compensation |
$170.51
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
6111406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
20300111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$386.80
|
| 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 |
$263.99
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
6111406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$309.60
|
| 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 |
$211.30
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$897.21
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
7211406
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$244.94 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$538.33
|
| Rate for Payer: Cash Price |
$538.33
|
| Rate for Payer: Cigna Commercial |
$762.63
|
| Rate for Payer: First Health Commercial |
$807.49
|
| Rate for Payer: First Health Workers Compensation |
$346.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.49
|
| Rate for Payer: GEHA Commercial |
$717.77
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.49
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$816.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$628.05
|
| Rate for Payer: One Health Plan PPO/POS |
$807.49
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$672.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$358.88
|
| 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 |
$244.94
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$2,497.71
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
6111407
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.87 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,498.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$1,498.63
|
| Rate for Payer: Cash Price |
$1,498.63
|
| Rate for Payer: Cigna Commercial |
$2,123.05
|
| Rate for Payer: First Health Commercial |
$2,247.94
|
| Rate for Payer: First Health Workers Compensation |
$964.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,247.94
|
| Rate for Payer: GEHA Commercial |
$1,998.17
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,247.94
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$2,272.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,748.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,247.94
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,372.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,873.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,322.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$999.08
|
| 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 |
$681.87
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$897.21
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
8511406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$244.94 |
| Max. Negotiated Rate |
$852.35 |
| Rate for Payer: Cash Price |
$538.33
|
| Rate for Payer: Cigna Commercial |
$762.63
|
| Rate for Payer: First Health Commercial |
$807.49
|
| Rate for Payer: First Health Workers Compensation |
$346.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.49
|
| Rate for Payer: GEHA Commercial |
$628.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.49
|
| Rate for Payer: Multiplan All |
$816.46
|
| Rate for Payer: OMNI Networks Commercial |
$628.05
|
| Rate for Payer: One Health Plan PPO/POS |
$807.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.35
|
| Rate for Payer: Three Rivers Provider Network All |
$672.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.41
|
| Rate for Payer: Zelis Auto |
$358.88
|
| Rate for Payer: Zelis Worker's Compensation |
$244.94
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$7,291.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
1911406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,990.44 |
| Max. Negotiated Rate |
$6,926.45 |
| Rate for Payer: Cash Price |
$4,374.60
|
| Rate for Payer: Cigna Commercial |
$6,197.35
|
| Rate for Payer: First Health Commercial |
$6,561.90
|
| Rate for Payer: First Health Workers Compensation |
$2,815.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,561.90
|
| Rate for Payer: GEHA Commercial |
$5,103.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,561.90
|
| Rate for Payer: Multiplan All |
$6,634.81
|
| Rate for Payer: OMNI Networks Commercial |
$5,103.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,561.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,926.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,468.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,780.63
|
| Rate for Payer: Zelis Auto |
$2,916.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,990.44
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$2,497.71
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
6111407
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.87 |
| Max. Negotiated Rate |
$2,372.82 |
| Rate for Payer: Cash Price |
$1,498.63
|
| Rate for Payer: Cigna Commercial |
$2,123.05
|
| Rate for Payer: First Health Commercial |
$2,247.94
|
| Rate for Payer: First Health Workers Compensation |
$964.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,247.94
|
| Rate for Payer: GEHA Commercial |
$1,748.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,247.94
|
| Rate for Payer: Multiplan All |
$2,272.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,748.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,247.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,372.82
|
| Rate for Payer: Three Rivers Provider Network All |
$1,873.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,322.87
|
| Rate for Payer: Zelis Auto |
$999.08
|
| Rate for Payer: Zelis Worker's Compensation |
$681.87
|
|
