|
BB CROSS PRBC 4TH UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286602
|
|
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 5TH UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286603
|
|
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 5TH UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286603
|
|
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 6TH UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286604
|
|
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 6TH UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286604
|
|
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 7th UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286605
|
|
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 7th UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286605
|
|
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 8th UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286606
|
|
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 8th UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286606
|
|
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 9th UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286607
|
|
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 9th UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286607
|
|
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 PRBCs 10th UNIT
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286608
|
|
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 PRBCs 10th UNIT
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2286608
|
|
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 CRYOPRECIPITATE
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2232178
|
|
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 CRYOPRECIPITATE
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2232178
|
|
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 DIRECT COOMBS DAT
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2286880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$83.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$9.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$111.20
|
| Rate for Payer: GEHA Medicare |
$5.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Humana ChoiceCare |
$5.93
|
| Rate for Payer: Humana Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.39
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.16
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.78
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$118.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.39
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Medicare |
$4.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.47
|
| Rate for Payer: Zelis Worker's Compensation |
$6.85
|
|
|
BB DIRECT COOMBS DAT
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
2286880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$9.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$97.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.85
|
|
|
BB FFP PROCESSING AND STORAGE
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299016
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.03 |
| Max. Negotiated Rate |
$735.30 |
| 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 |
$464.40
|
| 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 |
$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 |
$80.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| 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 |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.07
|
| 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 |
$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 |
$735.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$160.08
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| 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 |
$719.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$80.04
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Medicare |
$68.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.05
|
| Rate for Payer: Zelis Worker's Compensation |
$211.30
|
|
|
BB FFP PROCESSING AND STORAGE
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299016
|
|
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 FFP UNIT 1
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299017
|
|
Hospital Revenue Code
|
383
|
| 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 FFP UNIT 1
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299017
|
|
Hospital Revenue Code
|
383
|
| 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 FFP UNIT 2
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299922
|
|
Hospital Revenue Code
|
383
|
| 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 FFP UNIT 2
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299922
|
|
Hospital Revenue Code
|
383
|
| 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 FFP UNIT 3
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299923
|
|
Hospital Revenue Code
|
383
|
| 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 FFP UNIT 3
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299923
|
|
Hospital Revenue Code
|
383
|
| 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
|
|
