|
MS-DRG 42.00: SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$14,604.68
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$3,228.40 |
| Max. Negotiated Rate |
$14,604.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,228.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,435.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,228.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,960.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,590.99
|
| Rate for Payer: GEHA Medicare |
$8,590.99
|
| Rate for Payer: Humana ChoiceCare |
$9,450.09
|
| Rate for Payer: Humana Medicare Advantage |
$8,590.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,432.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,960.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,590.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,604.68
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12,027.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,960.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,590.99
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,285.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,419.17
|
| Rate for Payer: United Healthcare Commercial |
$5,418.49
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,960.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,590.99
|
| Rate for Payer: Zelis Medicare |
$7,302.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,203.98
|
|
|
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
|
IP
|
$14,977.17
|
|
|
Service Code
|
MSDRG 194
|
| Min. Negotiated Rate |
$4,739.00 |
| Max. Negotiated Rate |
$14,977.17 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,642.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,627.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,810.10
|
| Rate for Payer: GEHA Medicare |
$8,810.10
|
| Rate for Payer: Humana ChoiceCare |
$9,691.11
|
| Rate for Payer: Humana Medicare Advantage |
$8,810.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,800.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,627.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,810.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,977.17
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12,334.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,627.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,810.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,598.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,633.90
|
| Rate for Payer: United Healthcare Commercial |
$5,592.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,627.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,810.10
|
| Rate for Payer: Zelis Medicare |
$7,488.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,371.00
|
|
|
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
|
IP
|
$23,318.12
|
|
|
Service Code
|
MSDRG 193
|
| Min. Negotiated Rate |
$7,754.25 |
| Max. Negotiated Rate |
$23,318.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,754.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,673.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,754.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13,950.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13,716.54
|
| Rate for Payer: GEHA Medicare |
$13,716.54
|
| Rate for Payer: Humana ChoiceCare |
$15,088.19
|
| Rate for Payer: Humana Medicare Advantage |
$13,716.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23,043.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13,950.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13,716.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23,318.12
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,203.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13,950.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13,716.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,614.65
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,442.21
|
| Rate for Payer: United Healthcare Commercial |
$8,986.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13,950.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,716.54
|
| Rate for Payer: Zelis Medicare |
$11,659.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,630.93
|
|
|
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
|
IP
|
$12,095.09
|
|
|
Service Code
|
MSDRG 195
|
| Min. Negotiated Rate |
$2,965.55 |
| Max. Negotiated Rate |
$12,095.09 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,965.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,043.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,965.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,496.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,114.76
|
| Rate for Payer: GEHA Medicare |
$7,114.76
|
| Rate for Payer: Humana ChoiceCare |
$7,826.24
|
| Rate for Payer: Humana Medicare Advantage |
$7,114.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,952.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,496.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,114.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,095.09
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,960.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,496.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,114.76
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,174.11
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,972.46
|
| Rate for Payer: United Healthcare Commercial |
$4,246.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,496.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,114.76
|
| Rate for Payer: Zelis Medicare |
$6,047.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,078.68
|
|
|
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$96,286.04
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$29,834.35 |
| Max. Negotiated Rate |
$96,286.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29,834.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44,072.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29,834.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52,929.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56,638.85
|
| Rate for Payer: GEHA Medicare |
$56,638.85
|
| Rate for Payer: Humana ChoiceCare |
$62,302.74
|
| Rate for Payer: Humana Medicare Advantage |
$56,638.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$95,153.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$52,929.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56,638.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96,286.04
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$79,294.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$52,929.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56,638.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$80,993.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55,506.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52,929.42
|
| Rate for Payer: Zelis Medicare |
$48,143.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35,639.21
|
|
|
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$140,282.06
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$33,187.00 |
| Max. Negotiated Rate |
$140,282.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33,187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64,211.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33,187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$58,847.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$82,518.86
|
| Rate for Payer: GEHA Medicare |
$82,518.86
|
| Rate for Payer: Humana ChoiceCare |
$90,770.75
|
| Rate for Payer: Humana Medicare Advantage |
$82,518.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$138,631.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$58,847.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$82,518.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$140,282.06
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$115,526.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$58,847.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$82,518.86
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$118,001.97
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80,868.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58,847.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82,518.86
|
| Rate for Payer: Zelis Medicare |
$70,141.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51,923.82
|
|
|
MS-DRG 42.00: SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$69,230.56
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$12,284.30 |
| Max. Negotiated Rate |
$69,230.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,284.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31,688.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,284.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21,947.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$40,723.86
|
| Rate for Payer: GEHA Medicare |
$40,723.86
|
| Rate for Payer: Humana ChoiceCare |
$44,796.25
|
| Rate for Payer: Humana Medicare Advantage |
$40,723.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$68,416.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21,947.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$40,723.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$69,230.56
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57,013.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21,947.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$40,723.86
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$58,235.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39,909.38
|
| Rate for Payer: United Healthcare Commercial |
$26,681.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21,947.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40,723.86
|
| Rate for Payer: Zelis Medicare |
$34,615.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25,624.91
|
|
|
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$91,136.52
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$21,043.40 |
| Max. Negotiated Rate |
$91,136.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21,043.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41,715.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21,043.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$37,410.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$53,609.72
|
| Rate for Payer: GEHA Medicare |
$53,609.72
|
| Rate for Payer: Humana ChoiceCare |
$58,970.69
|
| Rate for Payer: Humana Medicare Advantage |
$53,609.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$90,064.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37,410.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$53,609.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$91,136.52
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$75,053.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37,410.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$53,609.72
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$76,661.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$52,537.53
|
| Rate for Payer: United Healthcare Commercial |
$35,123.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37,410.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53,609.72
|
| Rate for Payer: Zelis Medicare |
$45,568.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33,733.15
|
|
|
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$54,610.07
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$10,720.50 |
| Max. Negotiated Rate |
$54,610.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10,720.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24,996.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10,720.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19,186.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32,123.57
|
| Rate for Payer: GEHA Medicare |
$32,123.57
|
| Rate for Payer: Humana ChoiceCare |
$35,335.93
|
| Rate for Payer: Humana Medicare Advantage |
$32,123.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$53,967.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19,186.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32,123.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54,610.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$44,973.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19,186.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$32,123.57
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$45,936.71
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31,481.10
|
| Rate for Payer: United Healthcare Commercial |
$21,046.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19,186.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,123.57
|
| Rate for Payer: Zelis Medicare |
$27,305.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,213.30
|
|
|
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$42,666.99
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$3,699.50 |
| Max. Negotiated Rate |
$42,666.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,699.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19,529.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,699.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,792.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25,098.23
|
| Rate for Payer: GEHA Medicare |
$25,098.23
|
| Rate for Payer: Humana ChoiceCare |
$27,608.05
|
| Rate for Payer: Humana Medicare Advantage |
$25,098.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42,165.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,792.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25,098.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42,666.99
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35,137.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,792.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25,098.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35,890.47
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24,596.27
|
| Rate for Payer: United Healthcare Commercial |
$16,443.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,792.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,098.23
|
| Rate for Payer: Zelis Medicare |
$21,333.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15,792.70
|
|
|
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,310.30
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$2,739.80 |
| Max. Negotiated Rate |
$17,310.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,739.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,923.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,739.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,098.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,182.53
|
| Rate for Payer: GEHA Medicare |
$10,182.53
|
| Rate for Payer: Humana ChoiceCare |
$11,200.78
|
| Rate for Payer: Humana Medicare Advantage |
$10,182.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17,106.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,098.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,182.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,310.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14,255.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,098.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,182.53
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,561.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,978.88
|
| Rate for Payer: United Healthcare Commercial |
$6,671.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,098.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,182.53
|
| Rate for Payer: Zelis Medicare |
$8,655.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,407.21
|
|
|
MS-DRG 42.00: SKIN DEBRIDEMENT WITH CC
|
Facility
|
IP
|
$29,628.55
|
|
|
Service Code
|
MSDRG 571
|
| Min. Negotiated Rate |
$8,050.35 |
| Max. Negotiated Rate |
$29,628.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,050.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,561.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,050.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14,473.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,428.56
|
| Rate for Payer: GEHA Medicare |
$17,428.56
|
| Rate for Payer: Humana ChoiceCare |
$19,171.42
|
| Rate for Payer: Humana Medicare Advantage |
$17,428.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,279.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14,473.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,428.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,628.55
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24,399.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14,473.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,428.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,922.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,079.99
|
| Rate for Payer: United Healthcare Commercial |
$11,418.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14,473.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,428.56
|
| Rate for Payer: Zelis Medicare |
$14,814.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,966.67
|
|
|
MS-DRG 42.00: SKIN DEBRIDEMENT WITH MCC
|
Facility
|
IP
|
$53,268.70
|
|
|
Service Code
|
MSDRG 570
|
| Min. Negotiated Rate |
$13,493.90 |
| Max. Negotiated Rate |
$53,268.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,493.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24,382.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,493.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24,082.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$31,334.53
|
| Rate for Payer: GEHA Medicare |
$31,334.53
|
| Rate for Payer: Humana ChoiceCare |
$34,467.98
|
| Rate for Payer: Humana Medicare Advantage |
$31,334.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$52,642.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24,082.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$31,334.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$53,268.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43,868.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24,082.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$31,334.53
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$44,808.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30,707.84
|
| Rate for Payer: United Healthcare Commercial |
$20,529.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24,082.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,334.53
|
| Rate for Payer: Zelis Medicare |
$26,634.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19,716.81
|
|
|
MS-DRG 42.00: SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$20,215.99
|
|
|
Service Code
|
MSDRG 572
|
| Min. Negotiated Rate |
$4,943.40 |
| Max. Negotiated Rate |
$20,215.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,943.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,253.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,943.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,988.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11,891.76
|
| Rate for Payer: GEHA Medicare |
$11,891.76
|
| Rate for Payer: Humana ChoiceCare |
$13,080.94
|
| Rate for Payer: Humana Medicare Advantage |
$11,891.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19,978.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,988.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11,891.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,215.99
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16,648.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,988.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11,891.76
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,005.22
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,653.92
|
| Rate for Payer: United Healthcare Commercial |
$7,791.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,988.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,891.76
|
| Rate for Payer: Zelis Medicare |
$10,108.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,482.72
|
|
|
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$47,121.09
|
|
|
Service Code
|
MSDRG 577
|
| Min. Negotiated Rate |
$14,172.90 |
| Max. Negotiated Rate |
$47,121.09 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14,172.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21,568.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14,172.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25,281.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27,718.29
|
| Rate for Payer: GEHA Medicare |
$27,718.29
|
| Rate for Payer: Humana ChoiceCare |
$30,490.12
|
| Rate for Payer: Humana Medicare Advantage |
$27,718.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46,566.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25,281.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27,718.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47,121.09
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38,805.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25,281.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27,718.29
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39,637.15
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27,163.92
|
| Rate for Payer: United Healthcare Commercial |
$18,160.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25,281.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,718.29
|
| Rate for Payer: Zelis Medicare |
$23,560.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17,441.34
|
|
|
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$95,475.60
|
|
|
Service Code
|
MSDRG 576
|
| Min. Negotiated Rate |
$32,020.80 |
| Max. Negotiated Rate |
$95,475.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32,020.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43,701.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32,020.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56,789.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56,162.12
|
| Rate for Payer: GEHA Medicare |
$56,162.12
|
| Rate for Payer: Humana ChoiceCare |
$61,778.33
|
| Rate for Payer: Humana Medicare Advantage |
$56,162.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94,352.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$56,789.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56,162.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95,475.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78,626.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$56,789.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56,162.12
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$80,311.83
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55,038.88
|
| Rate for Payer: United Healthcare Commercial |
$36,795.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56,789.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56,162.12
|
| Rate for Payer: Zelis Medicare |
$47,737.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35,339.21
|
|
|
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$29,913.44
|
|
|
Service Code
|
MSDRG 578
|
| Min. Negotiated Rate |
$9,624.30 |
| Max. Negotiated Rate |
$29,913.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,624.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,692.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,624.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17,251.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,596.14
|
| Rate for Payer: GEHA Medicare |
$17,596.14
|
| Rate for Payer: Humana ChoiceCare |
$19,355.75
|
| Rate for Payer: Humana Medicare Advantage |
$17,596.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,561.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17,251.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,596.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,913.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24,634.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17,251.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,596.14
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25,162.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,244.22
|
| Rate for Payer: United Healthcare Commercial |
$11,528.53
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17,251.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,596.14
|
| Rate for Payer: Zelis Medicare |
$14,956.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,072.12
|
|
|
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$61,315.11
|
|
|
Service Code
|
MSDRG 574
|
| Min. Negotiated Rate |
$13,834.45 |
| Max. Negotiated Rate |
$61,315.11 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,834.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28,065.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,834.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24,684.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36,067.71
|
| Rate for Payer: GEHA Medicare |
$36,067.71
|
| Rate for Payer: Humana ChoiceCare |
$39,674.48
|
| Rate for Payer: Humana Medicare Advantage |
$36,067.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60,593.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24,684.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36,067.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61,315.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$50,494.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24,684.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36,067.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$51,576.83
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35,346.36
|
| Rate for Payer: United Healthcare Commercial |
$23,630.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24,684.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,067.71
|
| Rate for Payer: Zelis Medicare |
$30,657.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22,695.10
|
|
|
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$108,975.93
|
|
|
Service Code
|
MSDRG 573
|
| Min. Negotiated Rate |
$26,041.40 |
| Max. Negotiated Rate |
$108,975.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26,041.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49,881.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26,041.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$46,233.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$64,103.49
|
| Rate for Payer: GEHA Medicare |
$64,103.49
|
| Rate for Payer: Humana ChoiceCare |
$70,513.84
|
| Rate for Payer: Humana Medicare Advantage |
$64,103.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$107,693.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46,233.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$64,103.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108,975.93
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$89,744.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46,233.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$64,103.49
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$91,667.99
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$62,821.42
|
| Rate for Payer: United Healthcare Commercial |
$41,998.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46,233.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64,103.49
|
| Rate for Payer: Zelis Medicare |
$54,487.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40,336.21
|
|
|
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,333.74
|
|
|
Service Code
|
MSDRG 575
|
| Min. Negotiated Rate |
$9,947.35 |
| Max. Negotiated Rate |
$35,333.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,947.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,173.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,947.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17,822.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20,784.55
|
| Rate for Payer: GEHA Medicare |
$20,784.55
|
| Rate for Payer: Humana ChoiceCare |
$22,863.01
|
| Rate for Payer: Humana Medicare Advantage |
$20,784.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17,822.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20,784.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35,333.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29,098.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17,822.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20,784.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29,721.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20,368.86
|
| Rate for Payer: United Healthcare Commercial |
$13,617.49
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17,822.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,784.55
|
| Rate for Payer: Zelis Medicare |
$17,666.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,078.39
|
|
|
MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$33,849.06
|
|
|
Service Code
|
MSDRG 623
|
| Min. Negotiated Rate |
$8,249.85 |
| Max. Negotiated Rate |
$33,849.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,493.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14,825.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,911.21
|
| Rate for Payer: GEHA Medicare |
$19,911.21
|
| Rate for Payer: Humana ChoiceCare |
$21,902.33
|
| Rate for Payer: Humana Medicare Advantage |
$19,911.21
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$33,450.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14,825.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,911.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33,849.06
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27,875.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14,825.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,911.21
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28,473.03
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,512.99
|
| Rate for Payer: United Healthcare Commercial |
$13,045.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14,825.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,911.21
|
| Rate for Payer: Zelis Medicare |
$16,924.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,528.84
|
|
|
MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$66,218.67
|
|
|
Service Code
|
MSDRG 622
|
| Min. Negotiated Rate |
$15,625.75 |
| Max. Negotiated Rate |
$66,218.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15,625.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30,310.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15,625.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27,846.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$38,952.16
|
| Rate for Payer: GEHA Medicare |
$38,952.16
|
| Rate for Payer: Humana ChoiceCare |
$42,847.38
|
| Rate for Payer: Humana Medicare Advantage |
$38,952.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$65,439.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27,846.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$38,952.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66,218.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$54,533.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27,846.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$38,952.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$55,701.59
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38,173.12
|
| Rate for Payer: United Healthcare Commercial |
$25,520.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27,846.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,952.16
|
| Rate for Payer: Zelis Medicare |
$33,109.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24,510.10
|
|
|
MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,750.92
|
|
|
Service Code
|
MSDRG 624
|
| Min. Negotiated Rate |
$5,884.20 |
| Max. Negotiated Rate |
$17,750.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,884.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,125.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,884.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10,649.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,441.72
|
| Rate for Payer: GEHA Medicare |
$10,441.72
|
| Rate for Payer: Humana ChoiceCare |
$11,485.89
|
| Rate for Payer: Humana Medicare Advantage |
$10,441.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17,542.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10,649.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,441.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,750.92
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14,618.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10,649.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,441.72
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,931.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,232.89
|
| Rate for Payer: United Healthcare Commercial |
$6,841.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10,649.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,441.72
|
| Rate for Payer: Zelis Medicare |
$8,875.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,570.31
|
|
|
MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$68,326.28
|
|
|
Service Code
|
MSDRG 904
|
| Min. Negotiated Rate |
$14,413.70 |
| Max. Negotiated Rate |
$68,326.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14,413.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31,274.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14,413.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25,706.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$40,191.93
|
| Rate for Payer: GEHA Medicare |
$40,191.93
|
| Rate for Payer: Humana ChoiceCare |
$44,211.12
|
| Rate for Payer: Humana Medicare Advantage |
$40,191.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$67,522.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25,706.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$40,191.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$68,326.28
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$56,268.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25,706.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$40,191.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$57,474.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39,388.09
|
| Rate for Payer: United Healthcare Commercial |
$26,332.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25,706.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40,191.93
|
| Rate for Payer: Zelis Medicare |
$34,163.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25,290.21
|
|
|
MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,166.66
|
|
|
Service Code
|
MSDRG 905
|
| Min. Negotiated Rate |
$5,415.20 |
| Max. Negotiated Rate |
$29,166.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,415.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,350.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,415.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,821.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,156.86
|
| Rate for Payer: GEHA Medicare |
$17,156.86
|
| Rate for Payer: Humana ChoiceCare |
$18,872.55
|
| Rate for Payer: Humana Medicare Advantage |
$17,156.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,823.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,821.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,156.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,166.66
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24,019.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,821.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,156.86
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,534.31
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,813.72
|
| Rate for Payer: United Healthcare Commercial |
$11,240.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,821.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,156.86
|
| Rate for Payer: Zelis Medicare |
$14,583.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,795.71
|
|
