|
BARIUM SULFATE FOR SUSP 98%
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 32909076401
|
| Hospital Charge Code |
3300087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: First Health Workers Compensation |
$18.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$37.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.83
|
|
|
BARIUM SULFATE SUSP 0.1%
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
NDC 32909094503
|
| Hospital Charge Code |
3300090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$37.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
BARIUM SULFATE SUSP 0.1%
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
NDC 32909094503
|
| Hospital Charge Code |
3300090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$42.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Humana ChoiceCare |
$13.78
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.80
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.50
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
BARIUM SULFATE SUSP 24%
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
NDC 32909014506
|
| Hospital Charge Code |
3300091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.87 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: First Health Workers Compensation |
$73.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$133.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
| Rate for Payer: Zelis Worker's Compensation |
$51.87
|
|
|
BARIUM SULFATE SUSP 24%
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
NDC 32909014506
|
| Hospital Charge Code |
3300091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: First Health Workers Compensation |
$73.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Humana ChoiceCare |
$49.40
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.00
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$167.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.00
|
| Rate for Payer: Zelis Worker's Compensation |
$51.87
|
|
|
BARIUM SULFATE TAB 700MG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
3300092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$14.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Humana ChoiceCare |
$4.68
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.80
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
BARIUM SULFATE TAB 700MG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 10361077831
|
| Hospital Charge Code |
3300092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: First Health Commercial |
$16.20
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16.20
|
| Rate for Payer: GEHA Commercial |
$12.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16.20
|
| Rate for Payer: Multiplan All |
$16.38
|
| Rate for Payer: OMNI Networks Commercial |
$12.60
|
| Rate for Payer: One Health Plan PPO/POS |
$16.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17.10
|
| Rate for Payer: Three Rivers Provider Network All |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16.74
|
| Rate for Payer: Zelis Auto |
$7.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
BASIC METABOLIC PROFILE (Vitros)
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
2232191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.46
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$14.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$8.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$9.31
|
| Rate for Payer: Humana Medicare Advantage |
$8.46
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.46
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.38
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.92
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.29
|
| Rate for Payer: United Healthcare Commercial |
$266.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.46
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.46
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$7.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.15
|
| Rate for Payer: Zelis Worker's Compensation |
$10.46
|
|
|
BASIC METABOLIC PROFILE (Vitros)
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
2232191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$14.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.46
|
|
|
BB ANTIBODY SCREEN AGH
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2232179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.77
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$14.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$9.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$10.75
|
| Rate for Payer: Humana Medicare Advantage |
$9.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.77
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.61
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.54
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.57
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.77
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$8.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.72
|
| Rate for Payer: Zelis Worker's Compensation |
$10.12
|
|
|
BB ANTIBODY SCREEN AGH
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2232179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$14.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.12
|
|
|
bb antibody screen REF006015
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2239421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.77
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$14.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$9.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$10.75
|
| Rate for Payer: Humana Medicare Advantage |
$9.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.77
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.61
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19.54
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.57
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.77
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$8.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.72
|
| Rate for Payer: Zelis Worker's Compensation |
$10.12
|
|
|
bb antibody screen REF006015
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
2239421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$14.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.12
|
|
|
BBB 1ST UNIT CHARGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2290016
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.82
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$172.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$190.10
|
| Rate for Payer: Humana Medicare Advantage |
$172.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$290.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$226.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.82
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.79
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$261.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$226.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.64
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$146.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.38
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 1ST UNIT CHARGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2290016
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 2ND UNIT CHARGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299917
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.82
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$172.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$190.10
|
| Rate for Payer: Humana Medicare Advantage |
$172.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$290.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$226.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.82
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.79
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$261.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$226.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.64
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$146.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.38
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 2ND UNIT CHARGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299917
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 3RD UNIT CHARGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299918
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.82
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$172.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$190.10
|
| Rate for Payer: Humana Medicare Advantage |
$172.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$290.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$226.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.82
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.79
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$261.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$226.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.64
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$146.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.38
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 3RD UNIT CHARGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299918
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 4TH UNIT CHARGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299919
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 4TH UNIT CHARGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299919
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.82
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$172.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$190.10
|
| Rate for Payer: Humana Medicare Advantage |
$172.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$290.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$226.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.82
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.79
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$261.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$226.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.64
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$146.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.38
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 5TH UNIT CHARGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299920
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.82
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$172.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$190.10
|
| Rate for Payer: Humana Medicare Advantage |
$172.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$290.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$226.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.82
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.79
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$261.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$226.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.64
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$146.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.38
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 5TH UNIT CHARGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299920
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 6TH UNIT CHARGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299921
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$280.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.82
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: GEHA Medicare |
$172.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$190.10
|
| Rate for Payer: Humana Medicare Advantage |
$172.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$290.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$226.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.82
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.79
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$261.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$226.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.64
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$146.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.38
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BBB 6TH UNIT CHARGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2299921
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: First Health Workers Compensation |
$298.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
