|
OPEN TX SEPTAL FX W/WO STABJ
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 21336
|
| Hospital Charge Code |
6121336
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.08 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$778.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$778.20
|
| Rate for Payer: Cash Price |
$778.20
|
| Rate for Payer: Cigna Commercial |
$1,102.45
|
| Rate for Payer: First Health Commercial |
$1,167.30
|
| Rate for Payer: First Health Workers Compensation |
$500.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,167.30
|
| Rate for Payer: GEHA Commercial |
$1,037.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,167.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,180.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$907.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,167.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,232.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$972.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,206.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$518.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$354.08
|
|
|
OPEN TX SEPTAL FX W/WO STABJ
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 21336
|
| Hospital Charge Code |
6121336
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.08 |
| Max. Negotiated Rate |
$1,232.15 |
| Rate for Payer: Cash Price |
$778.20
|
| Rate for Payer: Cigna Commercial |
$1,102.45
|
| Rate for Payer: First Health Commercial |
$1,167.30
|
| Rate for Payer: First Health Workers Compensation |
$500.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,167.30
|
| Rate for Payer: GEHA Commercial |
$907.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,167.30
|
| Rate for Payer: Multiplan All |
$1,180.27
|
| Rate for Payer: OMNI Networks Commercial |
$907.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,167.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,232.15
|
| Rate for Payer: Three Rivers Provider Network All |
$972.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,206.21
|
| Rate for Payer: Zelis Auto |
$518.80
|
| Rate for Payer: Zelis Worker's Compensation |
$354.08
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 32096
|
| Hospital Charge Code |
6132096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.83 |
| Max. Negotiated Rate |
$1,614.05 |
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,444.15
|
| Rate for Payer: First Health Commercial |
$1,529.10
|
| Rate for Payer: First Health Workers Compensation |
$655.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.10
|
| Rate for Payer: GEHA Commercial |
$1,189.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.10
|
| Rate for Payer: Multiplan All |
$1,546.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.07
|
| Rate for Payer: Zelis Auto |
$679.60
|
| Rate for Payer: Zelis Worker's Compensation |
$463.83
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 32096
|
| Hospital Charge Code |
6132096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.75 |
| Max. Negotiated Rate |
$1,614.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,019.40
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,444.15
|
| Rate for Payer: First Health Commercial |
$1,529.10
|
| Rate for Payer: First Health Workers Compensation |
$655.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.10
|
| Rate for Payer: GEHA Commercial |
$1,359.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.10
|
| Rate for Payer: Humana ChoiceCare |
$441.74
|
| Rate for Payer: Multiplan All |
$1,546.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,019.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,495.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$424.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.07
|
| Rate for Payer: Zelis Auto |
$679.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$849.50
|
| Rate for Payer: Zelis Worker's Compensation |
$463.83
|
|
|
OPEN WEDGE/BX LUNG NODULE
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
CPT 32097
|
| Hospital Charge Code |
6132097
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.50 |
| Max. Negotiated Rate |
$1,613.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$1,443.30
|
| Rate for Payer: First Health Commercial |
$1,528.20
|
| Rate for Payer: First Health Workers Compensation |
$655.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,528.20
|
| Rate for Payer: GEHA Commercial |
$1,358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,528.20
|
| Rate for Payer: Humana ChoiceCare |
$441.48
|
| Rate for Payer: Multiplan All |
$1,545.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,188.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,528.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,613.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,273.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,494.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,579.14
|
| Rate for Payer: Zelis Auto |
$679.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$849.00
|
| Rate for Payer: Zelis Worker's Compensation |
$463.55
|
|
|
OPEN WEDGE/BX LUNG NODULE
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
CPT 32097
|
| Hospital Charge Code |
6132097
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.55 |
| Max. Negotiated Rate |
$1,613.10 |
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$1,443.30
|
| Rate for Payer: First Health Commercial |
$1,528.20
|
| Rate for Payer: First Health Workers Compensation |
$655.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,528.20
|
| Rate for Payer: GEHA Commercial |
$1,188.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,528.20
|
| Rate for Payer: Multiplan All |
$1,545.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,188.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,528.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,613.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,579.14
|
| Rate for Payer: Zelis Auto |
$679.20
|
| Rate for Payer: Zelis Worker's Compensation |
$463.55
|
|
|
OPERATING RM 1-15 MIN
|
Facility
|
IP
|
$1,015.00
|
|
| Hospital Charge Code |
6180052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.10 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: First Health Workers Compensation |
$391.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Worker's Compensation |
$277.10
|
|
|
OPERATING RM 1-15 MIN
|
Facility
|
OP
|
$1,015.00
|
|
| Hospital Charge Code |
6180052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: First Health Workers Compensation |
$391.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Humana ChoiceCare |
$263.90
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$609.00
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$893.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$507.50
|
| Rate for Payer: Zelis Worker's Compensation |
$277.10
|
|
|
OPERATING RM 1-FIRST HOUR
|
Facility
|
IP
|
$4,060.00
|
|
| Hospital Charge Code |
6180051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,108.38 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$1,567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,108.38
|
|
|
OPERATING RM 1-FIRST HOUR
|
Facility
|
OP
|
$4,060.00
|
|
| Hospital Charge Code |
6180051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$1,567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Humana ChoiceCare |
$1,055.60
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,436.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,572.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,015.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,030.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,108.38
|
|
|
OPERATING RM 5-15 MIN
|
Facility
|
IP
|
$3,553.00
|
|
| Hospital Charge Code |
6180054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$969.97 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,020.05
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: First Health Workers Compensation |
$1,371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,197.70
|
| Rate for Payer: GEHA Commercial |
$2,487.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,197.70
|
| Rate for Payer: Multiplan All |
$3,233.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,487.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,197.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,375.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,664.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,304.29
|
| Rate for Payer: Zelis Auto |
$1,421.20
|
| Rate for Payer: Zelis Worker's Compensation |
$969.97
|
|
|
OPERATING RM 5-15 MIN
|
Facility
|
OP
|
$3,553.00
|
|
| Hospital Charge Code |
6180054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$888.25 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,131.80
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,020.05
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: First Health Workers Compensation |
$1,371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,197.70
|
| Rate for Payer: GEHA Commercial |
$2,842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,197.70
|
| Rate for Payer: Humana ChoiceCare |
$923.78
|
| Rate for Payer: Multiplan All |
$3,233.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,131.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,487.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,197.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,375.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,664.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,126.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$888.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,304.29
|
| Rate for Payer: Zelis Auto |
$1,421.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,776.50
|
| Rate for Payer: Zelis Worker's Compensation |
$969.97
|
|
|
OPERATING RM 5-FIRST HOUR
|
Facility
|
IP
|
$14,718.00
|
|
| Hospital Charge Code |
6180053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,018.01 |
| Max. Negotiated Rate |
$13,982.10 |
| Rate for Payer: Cash Price |
$8,830.80
|
| Rate for Payer: Cigna Commercial |
$12,510.30
|
| Rate for Payer: First Health Commercial |
$13,246.20
|
| Rate for Payer: First Health Workers Compensation |
$5,682.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,246.20
|
| Rate for Payer: GEHA Commercial |
$10,302.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,246.20
|
| Rate for Payer: Multiplan All |
$13,393.38
|
| Rate for Payer: OMNI Networks Commercial |
$10,302.60
|
| Rate for Payer: One Health Plan PPO/POS |
$13,246.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,982.10
|
| Rate for Payer: Three Rivers Provider Network All |
$11,038.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,687.74
|
| Rate for Payer: Zelis Auto |
$5,887.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4,018.01
|
|
|
OPERATING RM 5-FIRST HOUR
|
Facility
|
OP
|
$14,718.00
|
|
| Hospital Charge Code |
6180053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,679.50 |
| Max. Negotiated Rate |
$13,982.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,830.80
|
| Rate for Payer: Cash Price |
$8,830.80
|
| Rate for Payer: Cigna Commercial |
$12,510.30
|
| Rate for Payer: First Health Commercial |
$13,246.20
|
| Rate for Payer: First Health Workers Compensation |
$5,682.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,246.20
|
| Rate for Payer: GEHA Commercial |
$11,774.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,246.20
|
| Rate for Payer: Humana ChoiceCare |
$3,826.68
|
| Rate for Payer: Multiplan All |
$13,393.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,830.80
|
| Rate for Payer: OMNI Networks Commercial |
$10,302.60
|
| Rate for Payer: One Health Plan PPO/POS |
$13,246.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,982.10
|
| Rate for Payer: Three Rivers Provider Network All |
$11,038.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,951.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,687.74
|
| Rate for Payer: Zelis Auto |
$5,887.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,359.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4,018.01
|
|
|
OPERATING RM II 15"
|
Facility
|
OP
|
$1,218.00
|
|
| Hospital Charge Code |
6180001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$974.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Humana ChoiceCare |
$316.68
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$730.80
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,071.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$609.00
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
OPERATING RM II 15"
|
Facility
|
IP
|
$1,218.00
|
|
| Hospital Charge Code |
6180001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$852.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
OPERATING RM II 1ST HOUR
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
6180006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.57 |
| Max. Negotiated Rate |
$5,785.50 |
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cigna Commercial |
$5,176.50
|
| Rate for Payer: First Health Commercial |
$5,481.00
|
| Rate for Payer: First Health Workers Compensation |
$2,351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,481.00
|
| Rate for Payer: GEHA Commercial |
$4,263.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,481.00
|
| Rate for Payer: Multiplan All |
$5,541.90
|
| Rate for Payer: OMNI Networks Commercial |
$4,263.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,481.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,785.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,567.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,663.70
|
| Rate for Payer: Zelis Auto |
$2,436.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,662.57
|
|
|
OPERATING RM II 1ST HOUR
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
6180006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,522.50 |
| Max. Negotiated Rate |
$5,785.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cigna Commercial |
$5,176.50
|
| Rate for Payer: First Health Commercial |
$5,481.00
|
| Rate for Payer: First Health Workers Compensation |
$2,351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,481.00
|
| Rate for Payer: GEHA Commercial |
$4,872.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,481.00
|
| Rate for Payer: Humana ChoiceCare |
$1,583.40
|
| Rate for Payer: Multiplan All |
$5,541.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,654.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,263.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,481.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,785.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,567.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,359.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,663.70
|
| Rate for Payer: Zelis Auto |
$2,436.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,045.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,662.57
|
|
|
OPERATING RM III 15"
|
Facility
|
OP
|
$2,030.00
|
|
| Hospital Charge Code |
6180003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.50 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: First Health Workers Compensation |
$783.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,624.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Humana ChoiceCare |
$527.80
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,218.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,786.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$507.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,015.00
|
| Rate for Payer: Zelis Worker's Compensation |
$554.19
|
|
|
OPERATING RM III 15"
|
Facility
|
IP
|
$2,030.00
|
|
| Hospital Charge Code |
6180003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$554.19 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: First Health Workers Compensation |
$783.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,421.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Worker's Compensation |
$554.19
|
|
|
OPERATING RM III 1ST HOUR
|
Facility
|
IP
|
$7,714.00
|
|
| Hospital Charge Code |
6180007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.92 |
| Max. Negotiated Rate |
$7,328.30 |
| Rate for Payer: Cash Price |
$4,628.40
|
| Rate for Payer: Cigna Commercial |
$6,556.90
|
| Rate for Payer: First Health Commercial |
$6,942.60
|
| Rate for Payer: First Health Workers Compensation |
$2,978.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,942.60
|
| Rate for Payer: GEHA Commercial |
$5,399.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,942.60
|
| Rate for Payer: Multiplan All |
$7,019.74
|
| Rate for Payer: OMNI Networks Commercial |
$5,399.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,942.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,328.30
|
| Rate for Payer: Three Rivers Provider Network All |
$5,785.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,174.02
|
| Rate for Payer: Zelis Auto |
$3,085.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2,105.92
|
|
|
OPERATING RM III 1ST HOUR
|
Facility
|
OP
|
$7,714.00
|
|
| Hospital Charge Code |
6180007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.50 |
| Max. Negotiated Rate |
$7,328.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,628.40
|
| Rate for Payer: Cash Price |
$4,628.40
|
| Rate for Payer: Cigna Commercial |
$6,556.90
|
| Rate for Payer: First Health Commercial |
$6,942.60
|
| Rate for Payer: First Health Workers Compensation |
$2,978.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,942.60
|
| Rate for Payer: GEHA Commercial |
$6,171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,942.60
|
| Rate for Payer: Humana ChoiceCare |
$2,005.64
|
| Rate for Payer: Multiplan All |
$7,019.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,628.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,399.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,942.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,328.30
|
| Rate for Payer: Three Rivers Provider Network All |
$5,785.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,788.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,928.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,174.02
|
| Rate for Payer: Zelis Auto |
$3,085.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,857.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,105.92
|
|
|
OPERATING RM IV 15"
|
Facility
|
OP
|
$3,045.00
|
|
| Hospital Charge Code |
6180005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$761.25 |
| Max. Negotiated Rate |
$2,892.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$2,588.25
|
| Rate for Payer: First Health Commercial |
$2,740.50
|
| Rate for Payer: First Health Workers Compensation |
$1,175.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,740.50
|
| Rate for Payer: GEHA Commercial |
$2,436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,740.50
|
| Rate for Payer: Humana ChoiceCare |
$791.70
|
| Rate for Payer: Multiplan All |
$2,770.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,827.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,131.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,740.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,892.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,283.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,679.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,831.85
|
| Rate for Payer: Zelis Auto |
$1,218.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,522.50
|
| Rate for Payer: Zelis Worker's Compensation |
$831.28
|
|
|
OPERATING RM IV 15"
|
Facility
|
IP
|
$3,045.00
|
|
| Hospital Charge Code |
6180005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.28 |
| Max. Negotiated Rate |
$2,892.75 |
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$2,588.25
|
| Rate for Payer: First Health Commercial |
$2,740.50
|
| Rate for Payer: First Health Workers Compensation |
$1,175.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,740.50
|
| Rate for Payer: GEHA Commercial |
$2,131.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,740.50
|
| Rate for Payer: Multiplan All |
$2,770.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,131.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,740.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,892.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,283.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,831.85
|
| Rate for Payer: Zelis Auto |
$1,218.00
|
| Rate for Payer: Zelis Worker's Compensation |
$831.28
|
|
|
OPERATING RM IV 1ST HOUR
|
Facility
|
OP
|
$11,470.00
|
|
| Hospital Charge Code |
6180008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,867.50 |
| Max. Negotiated Rate |
$10,896.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,882.00
|
| Rate for Payer: Cash Price |
$6,882.00
|
| Rate for Payer: Cigna Commercial |
$9,749.50
|
| Rate for Payer: First Health Commercial |
$10,323.00
|
| Rate for Payer: First Health Workers Compensation |
$4,428.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,323.00
|
| Rate for Payer: GEHA Commercial |
$9,176.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,323.00
|
| Rate for Payer: Humana ChoiceCare |
$2,982.20
|
| Rate for Payer: Multiplan All |
$10,437.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,882.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,323.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,896.50
|
| Rate for Payer: Three Rivers Provider Network All |
$8,602.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,093.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,867.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,667.10
|
| Rate for Payer: Zelis Auto |
$4,588.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,735.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3,131.31
|
|
