|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$17,660.69
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$2,267.65 |
| Max. Negotiated Rate |
$17,660.69 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,267.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,083.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,267.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,264.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,388.64
|
| Rate for Payer: GEHA Medicare |
$10,388.64
|
| Rate for Payer: Humana ChoiceCare |
$11,427.50
|
| Rate for Payer: Humana Medicare Advantage |
$10,388.64
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17,452.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,264.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,388.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,660.69
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14,544.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,264.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,388.64
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,855.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,180.87
|
| Rate for Payer: United Healthcare Commercial |
$6,806.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,264.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,388.64
|
| Rate for Payer: Zelis Medicare |
$8,830.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,536.90
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$12,308.37
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$1,497.30 |
| Max. Negotiated Rate |
$12,308.37 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,497.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,162.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,497.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,904.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,240.22
|
| Rate for Payer: GEHA Medicare |
$7,240.22
|
| Rate for Payer: Humana ChoiceCare |
$7,964.24
|
| Rate for Payer: Humana Medicare Advantage |
$7,240.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12,163.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,904.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,240.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,308.37
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,136.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,904.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,240.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,353.51
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,095.42
|
| Rate for Payer: United Healthcare Commercial |
$4,346.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,904.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,240.22
|
| Rate for Payer: Zelis Medicare |
$6,154.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,174.31
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$17,142.02
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$2,500.05 |
| Max. Negotiated Rate |
$17,142.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,500.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,842.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,500.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,675.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,083.54
|
| Rate for Payer: GEHA Medicare |
$10,083.54
|
| Rate for Payer: Humana ChoiceCare |
$11,091.89
|
| Rate for Payer: Humana Medicare Advantage |
$10,083.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,940.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,675.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,083.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,142.02
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14,116.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,675.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,083.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,419.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,881.87
|
| Rate for Payer: United Healthcare Commercial |
$6,603.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,675.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,083.54
|
| Rate for Payer: Zelis Medicare |
$8,571.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,341.71
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$22,590.79
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$3,397.45 |
| Max. Negotiated Rate |
$22,590.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,397.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,340.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,397.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,259.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13,288.70
|
| Rate for Payer: GEHA Medicare |
$13,288.70
|
| Rate for Payer: Humana ChoiceCare |
$14,617.57
|
| Rate for Payer: Humana Medicare Advantage |
$13,288.70
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$22,325.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,259.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13,288.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22,590.79
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18,604.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,259.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13,288.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,002.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,022.93
|
| Rate for Payer: United Healthcare Commercial |
$8,706.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,259.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,288.70
|
| Rate for Payer: Zelis Medicare |
$11,295.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,361.73
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$17,142.02
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$2,268.35 |
| Max. Negotiated Rate |
$17,142.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,268.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,842.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,268.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,266.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,083.54
|
| Rate for Payer: GEHA Medicare |
$10,083.54
|
| Rate for Payer: Humana ChoiceCare |
$11,091.89
|
| Rate for Payer: Humana Medicare Advantage |
$10,083.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,940.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,266.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,083.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,142.02
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14,116.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,266.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,083.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,419.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,881.87
|
| Rate for Payer: United Healthcare Commercial |
$6,603.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,266.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,083.54
|
| Rate for Payer: Zelis Medicare |
$8,571.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,341.71
|
|
|
MS-DRG 42.00: VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$47,462.64
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$4,339.65 |
| Max. Negotiated Rate |
$47,462.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,339.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21,725.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,339.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,922.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27,919.20
|
| Rate for Payer: GEHA Medicare |
$27,919.20
|
| Rate for Payer: Humana ChoiceCare |
$30,711.12
|
| Rate for Payer: Humana Medicare Advantage |
$27,919.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46,904.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,922.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27,919.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47,462.64
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39,086.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,922.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27,919.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39,924.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27,360.82
|
| Rate for Payer: United Healthcare Commercial |
$18,291.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,922.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,919.20
|
| Rate for Payer: Zelis Medicare |
$23,731.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17,567.76
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$37,791.71
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$10,550.40 |
| Max. Negotiated Rate |
$37,791.71 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10,550.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17,298.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10,550.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18,886.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$22,230.42
|
| Rate for Payer: GEHA Medicare |
$22,230.42
|
| Rate for Payer: Humana ChoiceCare |
$24,453.46
|
| Rate for Payer: Humana Medicare Advantage |
$22,230.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$37,347.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18,886.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$22,230.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37,791.71
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31,122.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18,886.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$22,230.42
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$31,789.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21,785.81
|
| Rate for Payer: United Healthcare Commercial |
$14,564.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18,886.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,230.42
|
| Rate for Payer: Zelis Medicare |
$18,895.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,988.18
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$74,157.16
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$15,536.15 |
| Max. Negotiated Rate |
$74,157.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15,536.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33,943.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15,536.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27,688.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43,621.86
|
| Rate for Payer: GEHA Medicare |
$43,621.86
|
| Rate for Payer: Humana ChoiceCare |
$47,984.05
|
| Rate for Payer: Humana Medicare Advantage |
$43,621.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73,284.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27,688.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43,621.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74,157.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$61,070.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27,688.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43,621.86
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$62,379.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42,749.42
|
| Rate for Payer: United Healthcare Commercial |
$28,579.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27,688.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,621.86
|
| Rate for Payer: Zelis Medicare |
$37,078.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27,448.43
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,234.08
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$9,486.40 |
| Max. Negotiated Rate |
$28,234.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,486.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,923.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,486.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17,008.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16,608.28
|
| Rate for Payer: GEHA Medicare |
$16,608.28
|
| Rate for Payer: Humana ChoiceCare |
$18,269.11
|
| Rate for Payer: Humana Medicare Advantage |
$16,608.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27,901.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17,008.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16,608.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,234.08
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23,251.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17,008.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16,608.28
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23,749.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,276.11
|
| Rate for Payer: United Healthcare Commercial |
$10,881.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17,008.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,608.28
|
| Rate for Payer: Zelis Medicare |
$14,117.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,450.52
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$26,117.64
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$2,781.45 |
| Max. Negotiated Rate |
$26,117.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,781.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,954.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,781.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,171.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15,363.32
|
| Rate for Payer: GEHA Medicare |
$15,363.32
|
| Rate for Payer: Humana ChoiceCare |
$16,899.65
|
| Rate for Payer: Humana Medicare Advantage |
$15,363.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25,810.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,171.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15,363.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26,117.64
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21,508.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,171.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15,363.32
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21,969.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,056.05
|
| Rate for Payer: United Healthcare Commercial |
$10,065.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,171.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,363.32
|
| Rate for Payer: Zelis Medicare |
$13,058.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,667.15
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$15,923.76
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$2,049.25 |
| Max. Negotiated Rate |
$15,923.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,049.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,166.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,049.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,879.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,366.92
|
| Rate for Payer: GEHA Medicare |
$9,366.92
|
| Rate for Payer: Humana ChoiceCare |
$10,303.61
|
| Rate for Payer: Humana Medicare Advantage |
$9,366.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15,736.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,879.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,366.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,923.76
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13,113.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,879.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,366.92
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,394.70
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,179.58
|
| Rate for Payer: United Healthcare Commercial |
$6,034.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,879.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,366.92
|
| Rate for Payer: Zelis Medicare |
$7,961.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,795.44
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$30,479.72
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$3,007.20 |
| Max. Negotiated Rate |
$30,479.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,007.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,951.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,007.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,570.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,929.25
|
| Rate for Payer: GEHA Medicare |
$17,929.25
|
| Rate for Payer: Humana ChoiceCare |
$19,722.17
|
| Rate for Payer: Humana Medicare Advantage |
$17,929.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30,121.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,570.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,929.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,479.72
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25,100.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,570.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,929.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25,638.83
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,570.67
|
| Rate for Payer: United Healthcare Commercial |
$11,746.77
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,570.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,929.25
|
| Rate for Payer: Zelis Medicare |
$15,239.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,281.72
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,392.67
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$2,089.85 |
| Max. Negotiated Rate |
$16,392.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,089.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,426.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,089.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,950.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,642.75
|
| Rate for Payer: GEHA Medicare |
$9,642.75
|
| Rate for Payer: Humana ChoiceCare |
$10,607.02
|
| Rate for Payer: Humana Medicare Advantage |
$9,642.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,199.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,950.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,642.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,392.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13,499.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,950.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,642.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,789.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,449.90
|
| Rate for Payer: United Healthcare Commercial |
$6,253.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,950.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,642.75
|
| Rate for Payer: Zelis Medicare |
$8,196.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,005.69
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$52,178.61
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$13,651.40 |
| Max. Negotiated Rate |
$52,178.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,651.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$23,883.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,651.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24,361.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$30,693.30
|
| Rate for Payer: GEHA Medicare |
$30,693.30
|
| Rate for Payer: Humana ChoiceCare |
$33,762.63
|
| Rate for Payer: Humana Medicare Advantage |
$30,693.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$51,564.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24,361.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$30,693.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52,178.61
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42,970.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24,361.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$30,693.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$43,891.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30,079.43
|
| Rate for Payer: United Healthcare Commercial |
$20,109.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24,361.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,693.30
|
| Rate for Payer: Zelis Medicare |
$26,089.31
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19,313.33
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$95,576.48
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$29,966.65 |
| Max. Negotiated Rate |
$95,576.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29,966.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43,748.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29,966.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$53,162.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56,221.46
|
| Rate for Payer: GEHA Medicare |
$56,221.46
|
| Rate for Payer: Humana ChoiceCare |
$61,843.61
|
| Rate for Payer: Humana Medicare Advantage |
$56,221.46
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94,452.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53,162.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56,221.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95,576.48
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78,710.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53,162.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56,221.46
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$80,396.69
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55,097.03
|
| Rate for Payer: United Healthcare Commercial |
$36,834.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53,162.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56,221.46
|
| Rate for Payer: Zelis Medicare |
$47,788.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35,376.55
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$30,722.16
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$7,716.80 |
| Max. Negotiated Rate |
$30,722.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,716.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,062.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,716.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13,884.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18,071.86
|
| Rate for Payer: GEHA Medicare |
$18,071.86
|
| Rate for Payer: Humana ChoiceCare |
$19,879.05
|
| Rate for Payer: Humana Medicare Advantage |
$18,071.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30,360.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13,884.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18,071.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,722.16
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25,300.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13,884.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18,071.86
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25,842.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,710.42
|
| Rate for Payer: United Healthcare Commercial |
$11,840.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13,884.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,071.86
|
| Rate for Payer: Zelis Medicare |
$15,361.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,371.45
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$33,580.07
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$7,538.65 |
| Max. Negotiated Rate |
$33,580.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,538.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,370.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,538.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13,569.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,752.98
|
| Rate for Payer: GEHA Medicare |
$19,752.98
|
| Rate for Payer: Humana ChoiceCare |
$21,728.28
|
| Rate for Payer: Humana Medicare Advantage |
$19,752.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$33,185.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13,569.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,752.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33,580.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27,654.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13,569.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,752.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28,246.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,357.92
|
| Rate for Payer: United Healthcare Commercial |
$12,941.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13,569.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,752.98
|
| Rate for Payer: Zelis Medicare |
$16,790.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,429.28
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$78,402.44
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$26,913.95 |
| Max. Negotiated Rate |
$78,402.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26,913.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35,887.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26,913.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47,773.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$46,119.08
|
| Rate for Payer: GEHA Medicare |
$46,119.08
|
| Rate for Payer: Humana ChoiceCare |
$50,730.99
|
| Rate for Payer: Humana Medicare Advantage |
$46,119.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$77,480.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47,773.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$46,119.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$78,402.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$64,566.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$47,773.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$46,119.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$65,950.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45,196.70
|
| Rate for Payer: United Healthcare Commercial |
$30,216.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47,773.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,119.08
|
| Rate for Payer: Zelis Medicare |
$39,201.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29,019.78
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,573.29
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$4,147.15 |
| Max. Negotiated Rate |
$21,573.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,147.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,874.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,147.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,582.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,690.17
|
| Rate for Payer: GEHA Medicare |
$12,690.17
|
| Rate for Payer: Humana ChoiceCare |
$13,959.19
|
| Rate for Payer: Humana Medicare Advantage |
$12,690.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21,319.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,582.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,690.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,573.29
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17,766.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,582.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,690.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18,146.94
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,436.37
|
| Rate for Payer: United Healthcare Commercial |
$8,314.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,582.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,690.17
|
| Rate for Payer: Zelis Medicare |
$10,786.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,985.10
|
|
|
M/S DRUG INFUSION SEQUENTIAL HOUR
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
1000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
M/S HYDRATION EA ADDL HR
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
1000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
M/S HYDRATION EA ADDL HR W/MOD
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
1000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
M/S INFUSION EA ADDL HOUR
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
1000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
M/S INFUSION INITIAL (16 MIN TO 1 HOUR)
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
1000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$478.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| Rate for Payer: Multiplan All |
$621.53
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$648.85
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$635.19
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
|
M/S INITIAL HYDRATION 31-60 MIN
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
1000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: First Health Workers Compensation |
$244.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
