|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
8300012
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$326.78 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$462.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$837.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Worker's Compensation |
$326.78
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
8300012
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$326.78 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$462.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$326.78
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
OP
|
$1,111.14
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
20311446
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.34 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$666.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$666.68
|
| 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 |
$888.91
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,000.03
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,011.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$777.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,000.03
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,055.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$833.36
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,033.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$444.46
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$303.34
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
7911446
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$326.78 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$462.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$837.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Worker's Compensation |
$326.78
|
|
|
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
|
|
|
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 |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$2,717.63
|
| 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 |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| 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 |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M >4
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
7911446
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$326.78 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$462.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$326.78
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
OP
|
$388.68
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
8511440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$233.21
|
| Rate for Payer: Cash Price |
$233.21
|
| Rate for Payer: Cigna Commercial |
$330.38
|
| Rate for Payer: First Health Commercial |
$349.81
|
| Rate for Payer: First Health Workers Compensation |
$150.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.81
|
| Rate for Payer: GEHA Commercial |
$310.94
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.81
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$353.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$272.08
|
| Rate for Payer: One Health Plan PPO/POS |
$349.81
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$291.51
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$155.47
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$106.11
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
6111440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
OP
|
$388.68
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
7211440
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$233.21
|
| Rate for Payer: Cash Price |
$233.21
|
| Rate for Payer: Cigna Commercial |
$330.38
|
| Rate for Payer: First Health Commercial |
$349.81
|
| Rate for Payer: First Health Workers Compensation |
$150.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.81
|
| Rate for Payer: GEHA Commercial |
$310.94
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.81
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$353.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$272.08
|
| Rate for Payer: One Health Plan PPO/POS |
$349.81
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$291.51
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$155.47
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$106.11
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
IP
|
$388.68
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
8511440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$369.25 |
| Rate for Payer: Cash Price |
$233.21
|
| Rate for Payer: Cigna Commercial |
$330.38
|
| Rate for Payer: First Health Commercial |
$349.81
|
| Rate for Payer: First Health Workers Compensation |
$150.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.81
|
| Rate for Payer: GEHA Commercial |
$272.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.81
|
| Rate for Payer: Multiplan All |
$353.70
|
| Rate for Payer: OMNI Networks Commercial |
$272.08
|
| Rate for Payer: One Health Plan PPO/POS |
$349.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.25
|
| Rate for Payer: Three Rivers Provider Network All |
$291.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.47
|
| Rate for Payer: Zelis Auto |
$155.47
|
| Rate for Payer: Zelis Worker's Compensation |
$106.11
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
9400025
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
6111440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$120.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$85.45
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
9400025
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.5/<
|
Facility
|
IP
|
$388.68
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
7211440
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$369.25 |
| Rate for Payer: Cash Price |
$233.21
|
| Rate for Payer: Cigna Commercial |
$330.38
|
| Rate for Payer: First Health Commercial |
$349.81
|
| Rate for Payer: First Health Workers Compensation |
$150.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$349.81
|
| Rate for Payer: GEHA Commercial |
$272.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$349.81
|
| Rate for Payer: Multiplan All |
$353.70
|
| Rate for Payer: OMNI Networks Commercial |
$272.08
|
| Rate for Payer: One Health Plan PPO/POS |
$349.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.25
|
| Rate for Payer: Three Rivers Provider Network All |
$291.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.47
|
| Rate for Payer: Zelis Auto |
$155.47
|
| Rate for Payer: Zelis Worker's Compensation |
$106.11
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.6-1
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
6111441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.6-1
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
6111441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.6-1
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9400026
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: First Health Workers Compensation |
$196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$357.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$139.23
|
|
|
EXC B9 LS MRGN XCP SK TG F/E/E/N/L/M.6-1
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9400026
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: First Health Workers Compensation |
$196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$408.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$139.23
|
|
|
EXC B9 LS MRGN XCP SK TG S/N/H/F/G 2.1-3
|
Facility
|
OP
|
$572.73
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
7211423
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$156.36 |
| 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 |
$343.64
|
| 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 |
$343.64
|
| Rate for Payer: Cash Price |
$343.64
|
| Rate for Payer: Cigna Commercial |
$486.82
|
| Rate for Payer: First Health Commercial |
$515.46
|
| Rate for Payer: First Health Workers Compensation |
$221.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$515.46
|
| Rate for Payer: GEHA Commercial |
$458.18
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$515.46
|
| 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 |
$521.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$400.91
|
| Rate for Payer: One Health Plan PPO/POS |
$515.46
|
| 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 |
$544.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$429.55
|
| 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 |
$532.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$229.09
|
| 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 |
$156.36
|
|
|
EXC B9 LS MRGN XCP SK TG S/N/H/F/G 2.1-3
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
20311423
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
EXC B9 LS MRGN XCP SK TG S/N/H/F/G 2.1-3
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
6111423
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
EXC B9 LS MRGN XCP SK TG S/N/H/F/G 2.1-3
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9400022
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$167.08 |
| 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 |
$367.20
|
| 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 |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$489.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| 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 |
$581.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$244.80
|
| 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 |
$167.08
|
|
|
EXC B9 LS MRGN XCP SK TG S/N/H/F/G 2.1-3
|
Facility
|
IP
|
$572.73
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
8511423
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.36 |
| Max. Negotiated Rate |
$544.09 |
| Rate for Payer: Cash Price |
$343.64
|
| Rate for Payer: Cigna Commercial |
$486.82
|
| Rate for Payer: First Health Commercial |
$515.46
|
| Rate for Payer: First Health Workers Compensation |
$221.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$515.46
|
| Rate for Payer: GEHA Commercial |
$400.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$515.46
|
| Rate for Payer: Multiplan All |
$521.18
|
| Rate for Payer: OMNI Networks Commercial |
$400.91
|
| Rate for Payer: One Health Plan PPO/POS |
$515.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$544.09
|
| Rate for Payer: Three Rivers Provider Network All |
$429.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$532.64
|
| Rate for Payer: Zelis Auto |
$229.09
|
| Rate for Payer: Zelis Worker's Compensation |
$156.36
|
|
|
EXC B9 LS MRGN XCP SK TG S/N/H/F/G 2.1-3
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9400022
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$428.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
