|
BB FFP UNIT 4
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299924
|
|
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 4
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299924
|
|
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 5
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299926
|
|
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 FFP UNIT 5
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299926
|
|
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 FFP UNIT 6
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299927
|
|
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 FFP UNIT 6
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299927
|
|
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 FFP UNIT 7
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299928
|
|
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 FFP UNIT 7
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299928
|
|
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 FFP UNIT 8
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299929
|
|
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 FFP UNIT 8
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
2299929
|
|
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 PLATELET UNIT1
|
Facility
|
IP
|
$2,161.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
2299035
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$589.95 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,512.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
BB PLATELET UNIT1
|
Facility
|
OP
|
$2,161.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
2299035
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$393.14 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,296.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$608.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$462.52
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,728.80
|
| Rate for Payer: GEHA Medicare |
$462.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Humana ChoiceCare |
$508.77
|
| Rate for Payer: Humana Medicare Advantage |
$462.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$777.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$620.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$462.52
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$786.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$716.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$620.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$462.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$925.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$620.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$462.52
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Medicare |
$393.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$555.02
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
BB PLATELET UNIT2
|
Facility
|
IP
|
$2,161.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
2299925
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$589.95 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,512.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
BB PLATELET UNIT2
|
Facility
|
OP
|
$2,161.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
2299925
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$393.14 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,296.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$608.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$462.52
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,728.80
|
| Rate for Payer: GEHA Medicare |
$462.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Humana ChoiceCare |
$508.77
|
| Rate for Payer: Humana Medicare Advantage |
$462.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$777.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$620.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$462.52
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$786.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$716.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$620.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$462.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$925.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$620.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$462.52
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Medicare |
$393.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$555.02
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
BB PLT PROCESSING AND STORAGE
|
Facility
|
OP
|
$2,161.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
2299032
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$393.14 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,296.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$608.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$462.52
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,728.80
|
| Rate for Payer: GEHA Medicare |
$462.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Humana ChoiceCare |
$508.77
|
| Rate for Payer: Humana Medicare Advantage |
$462.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$777.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$620.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$462.52
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$786.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$716.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$620.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$462.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$925.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$620.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$462.52
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Medicare |
$393.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$555.02
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
BB PLT PROCESSING AND STORAGE
|
Facility
|
IP
|
$2,161.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
2299032
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$589.95 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,512.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
BB RH TYPE AGH
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2286901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$88.35 |
| 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 |
$55.80
|
| 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 |
$37.27
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$6.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$74.40
|
| Rate for Payer: GEHA Medicare |
$37.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$41.00
|
| Rate for Payer: Humana Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$62.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$37.27
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.36
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| 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 |
$37.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$74.54
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$79.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.27
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Medicare |
$31.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.72
|
| Rate for Payer: Zelis Worker's Compensation |
$4.68
|
|
|
BB RH TYPE AGH
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2286901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$6.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.68
|
|
|
BCG VACCINE, PERCUT
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 90585
|
| Hospital Charge Code |
8590585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
BCG VACCINE, PERCUT
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 90585
|
| Hospital Charge Code |
8590585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$259.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$259.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$205.72
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$80.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$209.91
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$186.00
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$242.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$209.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$272.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$155.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
B COMPLEX/C/FA TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
3303028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
B COMPLEX/C/FA TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00536730001
|
| Hospital Charge Code |
3303028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
B-COMPLEX VITAMIN TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 24385097778
|
| Hospital Charge Code |
3300093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
B-COMPLEX VITAMIN TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 24385097778
|
| Hospital Charge Code |
3300093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
bcr-abl1, cml/all, pcr,qn REF480481
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
22990743
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.11 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$144.84
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$217.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: GEHA Medicare |
$144.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$159.32
|
| Rate for Payer: Humana Medicare Advantage |
$144.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$243.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$210.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$144.84
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$246.23
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$243.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$210.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$144.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$289.68
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$141.94
|
| Rate for Payer: United Healthcare Commercial |
$446.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$210.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$144.84
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Medicare |
$123.11
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$173.81
|
| Rate for Payer: Zelis Worker's Compensation |
$153.69
|
|
