|
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
|
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
|
OP
|
$7,291.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
1911406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$6,926.45 |
| 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 |
$4,374.60
|
| 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 |
$4,374.60
|
| 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 |
$5,832.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,561.90
|
| 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 |
$6,634.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$5,103.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,561.90
|
| 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 |
$6,926.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$5,468.25
|
| 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 |
$6,780.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$2,916.40
|
| 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 |
$1,990.44
|
|
|
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
|
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
|
|
|
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 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
6111442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.79 |
| 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 |
$333.60
|
| 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 |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$444.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| 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 |
$505.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| 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 |
$528.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| 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 |
$517.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
IP
|
$533.61
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
8511442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$506.93 |
| Rate for Payer: Cash Price |
$320.17
|
| Rate for Payer: Cigna Commercial |
$453.57
|
| Rate for Payer: First Health Commercial |
$480.25
|
| Rate for Payer: First Health Workers Compensation |
$206.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.25
|
| Rate for Payer: GEHA Commercial |
$373.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.25
|
| Rate for Payer: Multiplan All |
$485.59
|
| Rate for Payer: OMNI Networks Commercial |
$373.53
|
| Rate for Payer: One Health Plan PPO/POS |
$480.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.93
|
| Rate for Payer: Three Rivers Provider Network All |
$400.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.26
|
| Rate for Payer: Zelis Auto |
$213.44
|
| Rate for Payer: Zelis Worker's Compensation |
$145.68
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9400027
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$389.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
OP
|
$533.61
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
8511442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.68 |
| 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 |
$320.17
|
| 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 |
$320.17
|
| Rate for Payer: Cash Price |
$320.17
|
| Rate for Payer: Cigna Commercial |
$453.57
|
| Rate for Payer: First Health Commercial |
$480.25
|
| Rate for Payer: First Health Workers Compensation |
$206.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.25
|
| Rate for Payer: GEHA Commercial |
$426.89
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.25
|
| 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 |
$485.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$373.53
|
| Rate for Payer: One Health Plan PPO/POS |
$480.25
|
| 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 |
$506.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$400.21
|
| 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 |
$496.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$213.44
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$145.68
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9400027
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$151.79 |
| 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 |
$333.60
|
| 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 |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$444.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| 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 |
$505.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| 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 |
$528.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| 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 |
$517.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
6111442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$389.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
OP
|
$533.61
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
7211442
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$145.68 |
| 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 |
$320.17
|
| 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 |
$320.17
|
| Rate for Payer: Cash Price |
$320.17
|
| Rate for Payer: Cigna Commercial |
$453.57
|
| Rate for Payer: First Health Commercial |
$480.25
|
| Rate for Payer: First Health Workers Compensation |
$206.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.25
|
| Rate for Payer: GEHA Commercial |
$426.89
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.25
|
| 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 |
$485.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$373.53
|
| Rate for Payer: One Health Plan PPO/POS |
$480.25
|
| 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 |
$506.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$400.21
|
| 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 |
$496.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$213.44
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$145.68
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M1.1-2
|
Facility
|
IP
|
$533.61
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
7211442
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$506.93 |
| Rate for Payer: Cash Price |
$320.17
|
| Rate for Payer: Cigna Commercial |
$453.57
|
| Rate for Payer: First Health Commercial |
$480.25
|
| Rate for Payer: First Health Workers Compensation |
$206.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.25
|
| Rate for Payer: GEHA Commercial |
$373.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.25
|
| Rate for Payer: Multiplan All |
$485.59
|
| Rate for Payer: OMNI Networks Commercial |
$373.53
|
| Rate for Payer: One Health Plan PPO/POS |
$480.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.93
|
| Rate for Payer: Three Rivers Provider Network All |
$400.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.26
|
| Rate for Payer: Zelis Auto |
$213.44
|
| Rate for Payer: Zelis Worker's Compensation |
$145.68
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M2.1-3
|
Facility
|
IP
|
$653.79
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
6111443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$621.10 |
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cigna Commercial |
$555.72
|
| Rate for Payer: First Health Commercial |
$588.41
|
| Rate for Payer: First Health Workers Compensation |
$252.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.41
|
| Rate for Payer: GEHA Commercial |
$457.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.41
|
| Rate for Payer: Multiplan All |
$594.95
|
| Rate for Payer: OMNI Networks Commercial |
$457.65
|
| Rate for Payer: One Health Plan PPO/POS |
$588.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.10
|
| Rate for Payer: Three Rivers Provider Network All |
$490.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.02
|
| Rate for Payer: Zelis Auto |
$261.52
|
| Rate for Payer: Zelis Worker's Compensation |
$178.48
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M2.1-3
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9400028
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$186.19 |
| Max. Negotiated Rate |
$647.90 |
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$263.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$477.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Worker's Compensation |
$186.19
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M2.1-3
|
Facility
|
IP
|
$653.79
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
20311443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$621.10 |
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cigna Commercial |
$555.72
|
| Rate for Payer: First Health Commercial |
$588.41
|
| Rate for Payer: First Health Workers Compensation |
$252.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.41
|
| Rate for Payer: GEHA Commercial |
$457.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.41
|
| Rate for Payer: Multiplan All |
$594.95
|
| Rate for Payer: OMNI Networks Commercial |
$457.65
|
| Rate for Payer: One Health Plan PPO/POS |
$588.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.10
|
| Rate for Payer: Three Rivers Provider Network All |
$490.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.02
|
| Rate for Payer: Zelis Auto |
$261.52
|
| Rate for Payer: Zelis Worker's Compensation |
$178.48
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M2.1-3
|
Facility
|
OP
|
$653.79
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
20311443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$392.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cigna Commercial |
$555.72
|
| Rate for Payer: First Health Commercial |
$588.41
|
| Rate for Payer: First Health Workers Compensation |
$252.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.41
|
| Rate for Payer: GEHA Commercial |
$523.03
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.41
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$594.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$457.65
|
| Rate for Payer: One Health Plan PPO/POS |
$588.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$490.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$261.52
|
| 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 |
$178.48
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M2.1-3
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9400028
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$186.19 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$409.20
|
| 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 |
$1,538.48
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$263.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$545.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$272.80
|
| 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 |
$186.19
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M2.1-3
|
Facility
|
OP
|
$653.79
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
6111443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$392.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cash Price |
$392.27
|
| Rate for Payer: Cigna Commercial |
$555.72
|
| Rate for Payer: First Health Commercial |
$588.41
|
| Rate for Payer: First Health Workers Compensation |
$252.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.41
|
| Rate for Payer: GEHA Commercial |
$523.03
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.41
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$594.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$457.65
|
| Rate for Payer: One Health Plan PPO/POS |
$588.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$490.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$261.52
|
| 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 |
$178.48
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M3.1-4
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
9400029
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$234.51 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$515.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$515.40
|
| Rate for Payer: Cash Price |
$515.40
|
| Rate for Payer: Cigna Commercial |
$730.15
|
| Rate for Payer: First Health Commercial |
$773.10
|
| Rate for Payer: First Health Workers Compensation |
$331.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$773.10
|
| Rate for Payer: GEHA Commercial |
$687.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$773.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$781.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$601.30
|
| Rate for Payer: One Health Plan PPO/POS |
$773.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$816.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$644.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$798.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$343.60
|
| 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 |
$234.51
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M3.1-4
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
6111444
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$191.92 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cigna Commercial |
$597.55
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: First Health Workers Compensation |
$271.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$632.70
|
| Rate for Payer: GEHA Commercial |
$562.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$632.70
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$639.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$492.10
|
| Rate for Payer: One Health Plan PPO/POS |
$632.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$667.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$527.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$653.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$281.20
|
| 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 |
$191.92
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M3.1-4
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
9400029
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$234.51 |
| Max. Negotiated Rate |
$816.05 |
| Rate for Payer: Cash Price |
$515.40
|
| Rate for Payer: Cigna Commercial |
$730.15
|
| Rate for Payer: First Health Commercial |
$773.10
|
| Rate for Payer: First Health Workers Compensation |
$331.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$773.10
|
| Rate for Payer: GEHA Commercial |
$601.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$773.10
|
| Rate for Payer: Multiplan All |
$781.69
|
| Rate for Payer: OMNI Networks Commercial |
$601.30
|
| Rate for Payer: One Health Plan PPO/POS |
$773.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$816.05
|
| Rate for Payer: Three Rivers Provider Network All |
$644.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$798.87
|
| Rate for Payer: Zelis Auto |
$343.60
|
| Rate for Payer: Zelis Worker's Compensation |
$234.51
|
|
|
EXC B9 L MRGN XCP SK TG F/E/E/N/L/M3.1-4
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
6111444
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$191.92 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cigna Commercial |
$597.55
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: First Health Workers Compensation |
$271.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$632.70
|
| Rate for Payer: GEHA Commercial |
$492.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$632.70
|
| Rate for Payer: Multiplan All |
$639.73
|
| Rate for Payer: OMNI Networks Commercial |
$492.10
|
| Rate for Payer: One Health Plan PPO/POS |
$632.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$667.85
|
| Rate for Payer: Three Rivers Provider Network All |
$527.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$653.79
|
| Rate for Payer: Zelis Auto |
$281.20
|
| Rate for Payer: Zelis Worker's Compensation |
$191.92
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
IP
|
$1,111.14
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
20311446
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.34 |
| Max. Negotiated Rate |
$1,055.58 |
| Rate for Payer: Cash Price |
$666.68
|
| Rate for Payer: Cigna Commercial |
$944.47
|
| Rate for Payer: First Health Commercial |
$1,000.03
|
| Rate for Payer: First Health Workers Compensation |
$429.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,000.03
|
| Rate for Payer: GEHA Commercial |
$777.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,000.03
|
| Rate for Payer: Multiplan All |
$1,011.14
|
| Rate for Payer: OMNI Networks Commercial |
$777.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,000.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,055.58
|
| Rate for Payer: Three Rivers Provider Network All |
$833.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,033.36
|
| Rate for Payer: Zelis Auto |
$444.46
|
| Rate for Payer: Zelis Worker's Compensation |
$303.34
|
|
