|
BBB ANTIBODY TITER REF
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2200206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
BBB ANTIBODY TITER REF
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2200206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$6.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$7.29
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.63
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.27
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.26
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.50
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.63
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$5.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.96
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
BBB ANTIBODY TITER REF
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2300126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
BBB ANTIBODY TITER REF
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2300126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$6.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$7.29
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.63
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.27
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.26
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.50
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.63
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$5.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.96
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
BBB BLOOD TRANSFUSION SERVICE SET
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8136430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$680.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
BBB BLOOD TRANSFUSION SERVICE SET
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8136430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$793.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
BBB FFP THAW
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2286927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$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 |
$23.01
|
| 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 |
$16.27
|
|
|
BBB FFP THAW
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2286927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$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 |
$23.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$16.27
|
|
|
BB BLD PROCESSING AND STORAGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2232182
|
|
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
|
|
|
BB BLD PROCESSING AND STORAGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
2232182
|
|
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
|
|
|
BB BLD TYPE ABO
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
2286900
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$6.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$76.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Worker's Compensation |
$4.44
|
|
|
BB BLD TYPE ABO
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
2286900
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.99
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$6.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$87.20
|
| Rate for Payer: GEHA Medicare |
$2.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Humana ChoiceCare |
$3.29
|
| Rate for Payer: Humana Medicare Advantage |
$2.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.99
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.08
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5.98
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.93
|
| Rate for Payer: United Healthcare Commercial |
$92.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.99
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Medicare |
$2.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.59
|
| Rate for Payer: Zelis Worker's Compensation |
$4.44
|
|
|
BBB red blood cell ag typing REF006262
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2286905
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$6.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.51
|
|
|
BBB red blood cell ag typing REF006262
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
2286905
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$683.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$341.57
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$6.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: GEHA Medicare |
$341.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Humana ChoiceCare |
$375.73
|
| Rate for Payer: Humana Medicare Advantage |
$341.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$573.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$341.57
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$580.67
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$341.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$683.14
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.74
|
| Rate for Payer: United Healthcare Commercial |
$210.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$341.57
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Medicare |
$290.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$409.88
|
| Rate for Payer: Zelis Worker's Compensation |
$4.51
|
|
|
BB COVID-19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299930
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
BB COVID-19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299930
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$68.03 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$114.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$114.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$90.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$80.04
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: GEHA Medicare |
$80.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$88.04
|
| Rate for Payer: Humana Medicare Advantage |
$80.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$134.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$92.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$80.04
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.07
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$106.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$92.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$80.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$160.08
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$78.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$80.04
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Medicare |
$68.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.05
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
BB CROSSMATCH IGG
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2286922
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$148.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$42.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$151.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$151.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$138.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$29.74
|
|
|
BB CROSSMATCH IGG
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2286922
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$42.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.74
|
|
|
BB CROSS PRBC 1ST UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286920
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$148.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$151.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$151.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$217.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
BB CROSS PRBC 1ST UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286920
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
BB CROSS PRBC 2ND UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286600
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
BB CROSS PRBC 2ND UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286600
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$148.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$151.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$151.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$217.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
BB CROSS PRBC 3RD UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$187.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$148.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$151.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$151.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$217.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
BB CROSS PRBC 3RD UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
BB CROSS PRBC 4TH UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
