|
OPERATING RM IV 1ST HOUR
|
Facility
|
IP
|
$11,470.00
|
|
| Hospital Charge Code |
6180008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,131.31 |
| Max. Negotiated Rate |
$10,896.50 |
| 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 |
$8,029.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,323.00
|
| Rate for Payer: Multiplan All |
$10,437.70
|
| 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: United Payors & United Providers UP&UP |
$10,667.10
|
| Rate for Payer: Zelis Auto |
$4,588.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3,131.31
|
|
|
OPERATING ROOM MINOR
|
Facility
|
OP
|
$508.00
|
|
| Hospital Charge Code |
6180055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
OPERATING ROOM MINOR
|
Facility
|
IP
|
$508.00
|
|
| Hospital Charge Code |
6180055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
OPERATIVE UPPER GI ENDOSCOPY
|
Facility
|
IP
|
$4,006.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
6143251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,093.64 |
| Max. Negotiated Rate |
$3,805.70 |
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$3,405.10
|
| Rate for Payer: First Health Commercial |
$3,605.40
|
| Rate for Payer: First Health Workers Compensation |
$1,546.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,605.40
|
| Rate for Payer: GEHA Commercial |
$2,804.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,605.40
|
| Rate for Payer: Multiplan All |
$3,645.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,804.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,605.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,805.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,004.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,725.58
|
| Rate for Payer: Zelis Auto |
$1,602.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,093.64
|
|
|
OPERATIVE UPPER GI ENDOSCOPY
|
Facility
|
OP
|
$4,006.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
6143251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$3,805.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,403.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$3,405.10
|
| Rate for Payer: First Health Commercial |
$3,605.40
|
| Rate for Payer: First Health Workers Compensation |
$2,318.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,605.40
|
| Rate for Payer: GEHA Commercial |
$3,204.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,605.40
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$3,645.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,804.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,605.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,805.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$3,004.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,725.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$1,602.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$1,639.16
|
|
|
OPERATIVE UPPER GI ENDOSCOPY
|
Facility
|
OP
|
$4,146.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
6143247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$3,938.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,487.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$2,487.60
|
| Rate for Payer: Cash Price |
$2,487.60
|
| Rate for Payer: Cigna Commercial |
$3,524.10
|
| Rate for Payer: First Health Commercial |
$3,731.40
|
| Rate for Payer: First Health Workers Compensation |
$1,145.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,731.40
|
| Rate for Payer: GEHA Commercial |
$3,316.80
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,731.40
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$3,772.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,902.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,731.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,938.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,109.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,855.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$1,658.40
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$810.13
|
|
|
OPERATIVE UPPER GI ENDOSCOPY
|
Facility
|
IP
|
$4,146.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
6143247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,131.86 |
| Max. Negotiated Rate |
$3,938.70 |
| Rate for Payer: Cash Price |
$2,487.60
|
| Rate for Payer: Cigna Commercial |
$3,524.10
|
| Rate for Payer: First Health Commercial |
$3,731.40
|
| Rate for Payer: First Health Workers Compensation |
$1,600.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,731.40
|
| Rate for Payer: GEHA Commercial |
$2,902.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,731.40
|
| Rate for Payer: Multiplan All |
$3,772.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,902.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,731.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,938.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,855.78
|
| Rate for Payer: Zelis Auto |
$1,658.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,131.86
|
|
|
OP - GROUP 2 PT
|
Facility
|
IP
|
$305.00
|
|
| Hospital Charge Code |
21900212
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
OP - GROUP 2 PT
|
Facility
|
OP
|
$305.00
|
|
| Hospital Charge Code |
20500115
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
OP - GROUP 2 PT
|
Facility
|
IP
|
$305.00
|
|
| Hospital Charge Code |
20500115
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
OP - GROUP 2 PT
|
Facility
|
OP
|
$305.00
|
|
| Hospital Charge Code |
21900212
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
OP - GROUP 3 PT
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
21900213
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
OP - GROUP 3 PT
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
21900213
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$88.75 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$92.30
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$213.00
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$312.40
|
| Rate for Payer: United Healthcare Commercial |
$301.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$177.50
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
OP - GROUP 3 PT
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
20500116
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$88.75 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$92.30
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$213.00
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$312.40
|
| Rate for Payer: United Healthcare Commercial |
$301.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$177.50
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
OP - GROUP 3 PT
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
20500116
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
OP - IND PT TRNG
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
20500114
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
OP - IND PT TRNG
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
20500114
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
OP - IND PT TRNG
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
21900211
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
OP - IND PT TRNG
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
21900211
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
OPN TX COMPLX MALAR FX
|
Facility
|
IP
|
$2,292.00
|
|
|
Service Code
|
CPT 21365
|
| Hospital Charge Code |
6121365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$625.72 |
| Max. Negotiated Rate |
$2,177.40 |
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$1,948.20
|
| Rate for Payer: First Health Commercial |
$2,062.80
|
| Rate for Payer: First Health Workers Compensation |
$884.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,062.80
|
| Rate for Payer: GEHA Commercial |
$1,604.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,062.80
|
| Rate for Payer: Multiplan All |
$2,085.72
|
| Rate for Payer: OMNI Networks Commercial |
$1,604.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,062.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,177.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,131.56
|
| Rate for Payer: Zelis Auto |
$916.80
|
| Rate for Payer: Zelis Worker's Compensation |
$625.72
|
|
|
OPN TX COMPLX MALAR FX
|
Facility
|
OP
|
$2,292.00
|
|
|
Service Code
|
CPT 21365
|
| Hospital Charge Code |
6121365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$625.72 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,375.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$1,948.20
|
| Rate for Payer: First Health Commercial |
$2,062.80
|
| Rate for Payer: First Health Workers Compensation |
$884.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,062.80
|
| Rate for Payer: GEHA Commercial |
$1,833.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,062.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,085.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,604.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,062.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,177.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,131.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$916.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$625.72
|
|
|
OPN TX COMPLX MALAR W/GRFT
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
CPT 21366
|
| Hospital Charge Code |
6121366
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,433.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,630.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,433.40
|
| Rate for Payer: Cash Price |
$1,433.40
|
| Rate for Payer: Cigna Commercial |
$2,030.65
|
| Rate for Payer: First Health Commercial |
$2,150.10
|
| Rate for Payer: First Health Workers Compensation |
$922.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,150.10
|
| Rate for Payer: GEHA Commercial |
$1,911.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,150.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,765.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,173.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,672.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,150.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,811.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,765.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,269.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,791.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,765.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,221.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$955.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$652.20
|
|
|
OPN TX COMPLX MALAR W/GRFT
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
CPT 21366
|
| Hospital Charge Code |
6121366
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,269.55 |
| Rate for Payer: Cash Price |
$1,433.40
|
| Rate for Payer: Cigna Commercial |
$2,030.65
|
| Rate for Payer: First Health Commercial |
$2,150.10
|
| Rate for Payer: First Health Workers Compensation |
$922.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,150.10
|
| Rate for Payer: GEHA Commercial |
$1,672.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,150.10
|
| Rate for Payer: Multiplan All |
$2,173.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,672.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,150.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,269.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,791.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,221.77
|
| Rate for Payer: Zelis Auto |
$955.60
|
| Rate for Payer: Zelis Worker's Compensation |
$652.20
|
|
|
OPN TX DPRSD MALAR FRACTURE
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 21360
|
| Hospital Charge Code |
6121360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$935.00
|
| Rate for Payer: First Health Commercial |
$990.00
|
| Rate for Payer: First Health Workers Compensation |
$424.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.00
|
| Rate for Payer: GEHA Commercial |
$880.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,001.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$770.00
|
| Rate for Payer: One Health Plan PPO/POS |
$990.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$825.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$440.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$300.30
|
|
|
OPN TX DPRSD MALAR FRACTURE
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 21360
|
| Hospital Charge Code |
6121360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$935.00
|
| Rate for Payer: First Health Commercial |
$990.00
|
| Rate for Payer: First Health Workers Compensation |
$424.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.00
|
| Rate for Payer: GEHA Commercial |
$770.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.00
|
| Rate for Payer: Multiplan All |
$1,001.00
|
| Rate for Payer: OMNI Networks Commercial |
$770.00
|
| Rate for Payer: One Health Plan PPO/POS |
$990.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.00
|
| Rate for Payer: Three Rivers Provider Network All |
$825.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.00
|
| Rate for Payer: Zelis Auto |
$440.00
|
| Rate for Payer: Zelis Worker's Compensation |
$300.30
|
|
