|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
6116000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$55.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$101.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
6116000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$55.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$116.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
1900014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$386.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: First Health Workers Compensation |
$248.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$175.81
|
|
|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
21600200
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
20300014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
1900014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: First Health Workers Compensation |
$248.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$450.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Worker's Compensation |
$175.81
|
|
|
INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
8150036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
INITIAL VACCINE ADMINISTRATION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
7290471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INITIAL VACCINE ADMINISTRATION
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
7290471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
21999406
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$234.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$76.18
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.80
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.50
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
5099221
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$205.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
21799475
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$234.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$76.18
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.80
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.50
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
21799475
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$205.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
14099221
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$97.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$97.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$78.55
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$189.00
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$109.97
|
| Rate for Payer: First Health Workers Compensation |
$146.36
|
| Rate for Payer: GEHA Commercial |
$78.55
|
| Rate for Payer: GEHA Medicare |
$78.55
|
| Rate for Payer: Health Net Federal Services Government |
$78.55
|
| Rate for Payer: HealthSmart Commercial |
$109.97
|
| Rate for Payer: HealthSmart Worker's Compensation |
$140.45
|
| Rate for Payer: Humana ChoiceCare |
$86.41
|
| Rate for Payer: Humana Medicare Advantage |
$78.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$109.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$78.55
|
| Rate for Payer: Multiplan All |
$236.25
|
| Rate for Payer: National Preferred Provider Network Commercial |
$299.25
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$147.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.48
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$101.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$55.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$99.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.45
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$76.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.55
|
| Rate for Payer: Zelis Medicare |
$66.77
|
| Rate for Payer: Zelis Worker's Compensation |
$103.49
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
21999406
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$205.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
9899227
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
5099221
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$234.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$76.18
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.80
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.50
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/40 MIN
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
9899221
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
21999407
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
21999407
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$110.24
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.40
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$212.00
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
5099222
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$107.83 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$276.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
21799476
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
9899241
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
21799476
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$110.24
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.40
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$212.00
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/55 MIN
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
5099222
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$98.75 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$316.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Humana ChoiceCare |
$102.70
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$237.00
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$347.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$197.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
