|
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 |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| 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
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9400018
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$918.65 |
| 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 |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9400018
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
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
|
$897.21
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
7211406
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$244.94 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.49
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$816.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$672.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$358.88
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$244.94
|
|
|
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
|
$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/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 |
$1,363.52 |
| 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 |
$681.76
|
| 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 |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| 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 |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| 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
|
$556.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9400027
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$1,363.52 |
| 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 |
$681.76
|
| 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 |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| 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 |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| 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 |
9400027
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
| 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
|
|
|
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 |
$1,363.52 |
| 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 |
$681.76
|
| 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 |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.25
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$485.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| 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 |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$400.21
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$213.44
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| 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
|
$533.61
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
8511442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$1,363.52 |
| 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 |
$681.76
|
| 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 |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.25
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$485.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| 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 |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$400.21
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$213.44
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| 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 |
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/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
|
OP
|
$653.79
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
6111443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.41
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$594.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$490.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$261.52
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| 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 |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| 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 |
20311443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.41
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$594.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$490.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$261.52
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| 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/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 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
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
9400029
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$234.51 |
| Max. Negotiated Rate |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$773.10
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$781.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$816.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$644.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$798.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$343.60
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| 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 |
$3,139.96 |
| 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 |
$1,569.98
|
| 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 |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$632.70
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$639.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$667.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$527.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$653.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$281.20
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$191.92
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
6111446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$809.60
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
