|
BLOOD METHEMOGLOBIN ASSAY
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
22990965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.20
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$14.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: GEHA Medicare |
$8.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$9.02
|
| Rate for Payer: Humana Medicare Advantage |
$8.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.20
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.94
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16.40
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.04
|
| Rate for Payer: United Healthcare Commercial |
$90.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.20
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Medicare |
$6.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.84
|
| Rate for Payer: Zelis Worker's Compensation |
$10.45
|
|
|
BLOOD METHEMOGLOBIN ASSAY
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
22990965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$14.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$10.45
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
21600218
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: GEHA Medicare |
$4.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$4.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.38
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.45
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.76
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.38
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Medicare |
$3.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
21582270
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: GEHA Medicare |
$4.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$4.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.38
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.45
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.76
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.38
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Medicare |
$3.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
21600218
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
20300044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
25500038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
21582270
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
25500038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
20300044
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: GEHA Medicare |
$4.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$4.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.38
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.45
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.76
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.38
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Medicare |
$3.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
BLOOD TRANS EACH ADDL HOUR
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
1000017
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
BLOOD TRANS EACH ADDL HOUR
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
1000017
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
BLOOD TRANS FIRST HOUR
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
1000016
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
BLOOD TRANS FIRST HOUR
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
1000016
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
BLOOD TRANSFUSION SERVICE SET
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
1936430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,684.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,063.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Cigna Commercial |
$1,507.05
|
| Rate for Payer: First Health Commercial |
$1,595.70
|
| Rate for Payer: First Health Workers Compensation |
$684.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,595.70
|
| Rate for Payer: GEHA Commercial |
$1,418.40
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,595.70
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,613.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,241.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,595.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,684.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,648.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$709.20
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$484.03
|
|
|
BLOOD TRANSFUSION SERVICE SET
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
1936430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$484.03 |
| Max. Negotiated Rate |
$1,684.35 |
| Rate for Payer: Cash Price |
$1,063.80
|
| Rate for Payer: Cigna Commercial |
$1,507.05
|
| Rate for Payer: First Health Commercial |
$1,595.70
|
| Rate for Payer: First Health Workers Compensation |
$684.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,595.70
|
| Rate for Payer: GEHA Commercial |
$1,241.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,595.70
|
| Rate for Payer: Multiplan All |
$1,613.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,241.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,595.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,684.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,648.89
|
| Rate for Payer: Zelis Auto |
$709.20
|
| Rate for Payer: Zelis Worker's Compensation |
$484.03
|
|
|
BLOOD TRANS SET 1-2 UNIT
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6180038
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$793.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
BLOOD TRANS SET 1-2 UNIT
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6180038
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$680.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
BLOOD TRANS SET 2-4 UNT
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6180039
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,215.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$767.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$767.40
|
| Rate for Payer: Cash Price |
$767.40
|
| Rate for Payer: Cigna Commercial |
$1,087.15
|
| Rate for Payer: First Health Commercial |
$1,151.10
|
| Rate for Payer: First Health Workers Compensation |
$493.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,151.10
|
| Rate for Payer: GEHA Commercial |
$1,023.20
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,151.10
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,163.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$895.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,151.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,215.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$959.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,189.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$511.60
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$349.17
|
|
|
BLOOD TRANS SET 2-4 UNT
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6180039
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$349.17 |
| Max. Negotiated Rate |
$1,215.05 |
| Rate for Payer: Cash Price |
$767.40
|
| Rate for Payer: Cigna Commercial |
$1,087.15
|
| Rate for Payer: First Health Commercial |
$1,151.10
|
| Rate for Payer: First Health Workers Compensation |
$493.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,151.10
|
| Rate for Payer: GEHA Commercial |
$895.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,151.10
|
| Rate for Payer: Multiplan All |
$1,163.89
|
| Rate for Payer: OMNI Networks Commercial |
$895.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,151.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,215.05
|
| Rate for Payer: Three Rivers Provider Network All |
$959.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,189.47
|
| Rate for Payer: Zelis Auto |
$511.60
|
| Rate for Payer: Zelis Worker's Compensation |
$349.17
|
|
|
BLOOD TRANS SET >4UNITS
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6180040
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$914.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$415.12
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$1,295.40
|
| Rate for Payer: First Health Commercial |
$1,371.60
|
| Rate for Payer: First Health Workers Compensation |
$588.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,371.60
|
| Rate for Payer: GEHA Commercial |
$1,219.20
|
| Rate for Payer: GEHA Medicare |
$415.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,371.60
|
| Rate for Payer: Humana ChoiceCare |
$456.63
|
| Rate for Payer: Humana Medicare Advantage |
$415.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$697.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$276.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$415.12
|
| Rate for Payer: Multiplan All |
$1,386.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,371.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$319.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$276.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$415.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,447.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$830.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,417.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$415.12
|
| Rate for Payer: Zelis Auto |
$609.60
|
| Rate for Payer: Zelis Medicare |
$352.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.14
|
| Rate for Payer: Zelis Worker's Compensation |
$416.05
|
|
|
BLOOD TRANS SET >4UNITS
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6180040
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$416.05 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$1,295.40
|
| Rate for Payer: First Health Commercial |
$1,371.60
|
| Rate for Payer: First Health Workers Compensation |
$588.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,371.60
|
| Rate for Payer: GEHA Commercial |
$1,066.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,371.60
|
| Rate for Payer: Multiplan All |
$1,386.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,371.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,447.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,417.32
|
| Rate for Payer: Zelis Auto |
$609.60
|
| Rate for Payer: Zelis Worker's Compensation |
$416.05
|
|
|
BNP (Vitros)
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
2244444
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: First Health Workers Compensation |
$46.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.78
|
|
|
BNP (Vitros)
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
2244444
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$70.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$70.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$55.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: First Health Workers Compensation |
$46.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: GEHA Medicare |
$39.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$43.19
|
| Rate for Payer: Humana Medicare Advantage |
$39.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$65.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$39.26
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.74
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$65.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$39.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$78.52
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$285.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$39.26
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Medicare |
$33.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.11
|
| Rate for Payer: Zelis Worker's Compensation |
$32.78
|
|
|
Body Fluid Cell Count
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
2205028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$29.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.75
|
|
