|
POSTOP FOLLOW UP VISIT RELATED TO ORG PX
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
8399024
|
|
Hospital Revenue Code
|
519
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORG PX
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
7999024
|
|
Hospital Revenue Code
|
519
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
23500003
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
23500003
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
21999412
|
|
Hospital Revenue Code
|
960
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
21999412
|
|
Hospital Revenue Code
|
960
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
21600106
|
|
Hospital Revenue Code
|
517
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
21799481
|
|
Hospital Revenue Code
|
960
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
21600106
|
|
Hospital Revenue Code
|
517
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
20300043
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
20300043
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORIGIN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
21799481
|
|
Hospital Revenue Code
|
960
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
23500053
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
8964566
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$643.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$213.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$575.45
|
| Rate for Payer: First Health Commercial |
$609.30
|
| Rate for Payer: First Health Workers Compensation |
$261.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$609.30
|
| Rate for Payer: GEHA Commercial |
$541.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$609.30
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$218.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$616.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$473.90
|
| Rate for Payer: One Health Plan PPO/POS |
$609.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$251.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$218.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$643.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$507.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$629.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$270.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$184.82
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
9200016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
8964566
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$643.15 |
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$575.45
|
| Rate for Payer: First Health Commercial |
$609.30
|
| Rate for Payer: First Health Workers Compensation |
$261.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$609.30
|
| Rate for Payer: GEHA Commercial |
$473.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$609.30
|
| Rate for Payer: Multiplan All |
$616.07
|
| Rate for Payer: OMNI Networks Commercial |
$473.90
|
| Rate for Payer: One Health Plan PPO/POS |
$609.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$643.15
|
| Rate for Payer: Three Rivers Provider Network All |
$507.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$629.61
|
| Rate for Payer: Zelis Auto |
$270.80
|
| Rate for Payer: Zelis Worker's Compensation |
$184.82
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
6164566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$213.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$294.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$218.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$251.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$218.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
6164566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
9200016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$213.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$294.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$218.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$251.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$218.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
POST TIB NEUROSTIMULATION PRQ NDLE ELECT
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
23500053
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$269.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$213.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$294.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$218.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$251.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$218.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
potassium 24 hour urine REF003186
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
2200701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$72.25
|
| Rate for Payer: First Health Commercial |
$76.50
|
| Rate for Payer: First Health Workers Compensation |
$8.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$76.50
|
| Rate for Payer: GEHA Commercial |
$59.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$76.50
|
| Rate for Payer: Multiplan All |
$77.35
|
| Rate for Payer: OMNI Networks Commercial |
$59.50
|
| Rate for Payer: One Health Plan PPO/POS |
$76.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$80.75
|
| Rate for Payer: Three Rivers Provider Network All |
$63.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.05
|
| Rate for Payer: Zelis Auto |
$34.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.80
|
|
|
potassium 24 hour urine REF003186
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
2200701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$72.25
|
| Rate for Payer: First Health Commercial |
$76.50
|
| Rate for Payer: First Health Workers Compensation |
$8.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$76.50
|
| Rate for Payer: GEHA Commercial |
$68.00
|
| Rate for Payer: GEHA Medicare |
$4.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$76.50
|
| Rate for Payer: Humana ChoiceCare |
$5.20
|
| Rate for Payer: Humana Medicare Advantage |
$4.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.73
|
| Rate for Payer: Multiplan All |
$77.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.04
|
| Rate for Payer: OMNI Networks Commercial |
$59.50
|
| Rate for Payer: One Health Plan PPO/POS |
$76.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$80.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.46
|
| Rate for Payer: Three Rivers Provider Network All |
$63.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$72.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.73
|
| Rate for Payer: Zelis Auto |
$34.00
|
| Rate for Payer: Zelis Medicare |
$4.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.68
|
| Rate for Payer: Zelis Worker's Compensation |
$5.80
|
|
|
POTASSIUM ARTERIAL
|
Facility
|
OP
|
$95.47
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
4210021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$90.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$57.28
|
| Rate for Payer: Cash Price |
$57.28
|
| Rate for Payer: Cigna Commercial |
$81.15
|
| Rate for Payer: First Health Commercial |
$85.92
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.92
|
| Rate for Payer: GEHA Commercial |
$76.38
|
| Rate for Payer: GEHA Medicare |
$4.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.92
|
| Rate for Payer: Humana ChoiceCare |
$5.24
|
| Rate for Payer: Humana Medicare Advantage |
$4.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.76
|
| Rate for Payer: Multiplan All |
$86.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.09
|
| Rate for Payer: OMNI Networks Commercial |
$66.83
|
| Rate for Payer: One Health Plan PPO/POS |
$85.92
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.52
|
| Rate for Payer: Three Rivers Provider Network All |
$71.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.66
|
| Rate for Payer: United Healthcare Commercial |
$81.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.76
|
| Rate for Payer: Zelis Auto |
$38.19
|
| Rate for Payer: Zelis Medicare |
$4.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.71
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
POTASSIUM ARTERIAL
|
Facility
|
IP
|
$95.47
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
4210021
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$90.70 |
| Rate for Payer: Cash Price |
$57.28
|
| Rate for Payer: Cash Price |
$57.28
|
| Rate for Payer: Cigna Commercial |
$81.15
|
| Rate for Payer: First Health Commercial |
$85.92
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.92
|
| Rate for Payer: GEHA Commercial |
$66.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.92
|
| Rate for Payer: Multiplan All |
$86.88
|
| Rate for Payer: OMNI Networks Commercial |
$66.83
|
| Rate for Payer: One Health Plan PPO/POS |
$85.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.70
|
| Rate for Payer: Three Rivers Provider Network All |
$71.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.79
|
| Rate for Payer: Zelis Auto |
$38.19
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
POTASSIUM CHLORIDE 10MEQ TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904721661
|
| Hospital Charge Code |
3300737
|
|
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
|
|
