|
CHEMODENERV 1 EXTREM 1-4 EA
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
6164643
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
CHEMODENERV 1 EXTREM 1-4 EA
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
6164643
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
6164645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
| Rate for Payer: Zelis Worker's Compensation |
$71.80
|
|
|
CHEMODENERV 1 EXTREM 5/> EA
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
6164645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Worker's Compensation |
$71.80
|
|
|
CHEMODENERV 1 EXTREM 5/> MUS
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
6164644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
CHEMODENERV 1 EXTREM 5/> MUS
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
6164644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$259.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
CHEMODENERV 1 EXTREMITY 1-4
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
6164642
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$271.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
CHEMODENERV 1 EXTREMITY 1-4
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
6164642
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$237.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
CHEMODENERVATION ANAL MUSC
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
6146505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$2,423.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$366.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$488.80
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$556.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$580.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$568.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$244.40
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$166.80
|
|
|
CHEMODENERVATION ANAL MUSC
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
6146505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$427.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| Rate for Payer: Multiplan All |
$556.01
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$580.45
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$568.23
|
| Rate for Payer: Zelis Auto |
$244.40
|
| Rate for Payer: Zelis Worker's Compensation |
$166.80
|
|
|
CHEMODENERVATION OF ONE EXTREMITY; 1-4 MUSCLE(S)
|
Facility
|
OP
|
$1,315.16
|
|
|
Service Code
|
CPT 64642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$390.15 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: First Health Workers Compensation |
$846.31
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 1-4 MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$280.90
|
|
|
Service Code
|
CPT 64643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$198.62 |
| Max. Negotiated Rate |
$280.90 |
| Rate for Payer: First Health Workers Compensation |
$280.90
|
| Rate for Payer: Zelis Worker's Compensation |
$198.62
|
|
|
CHEMODENERVAT MUSCLE NECK UNILAT FOR DYS
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
6164616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$240.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
CHEMODENERVAT MUSCLE NECK UNILAT FOR DYS
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
6164616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$281.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$281.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$222.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| 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 |
$227.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$262.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$227.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
CHEMODENERVAT MUSCLE NECK UNILAT FOR DYS
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
7664616
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$281.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$281.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$222.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$274.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| 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 |
$227.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$262.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$227.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
CHEMODENERVAT MUSCLE NECK UNILAT FOR DYS
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
7664616
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: Cigna Commercial |
$291.55
|
| Rate for Payer: First Health Commercial |
$308.70
|
| Rate for Payer: First Health Workers Compensation |
$132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$308.70
|
| Rate for Payer: GEHA Commercial |
$240.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$308.70
|
| Rate for Payer: Multiplan All |
$312.13
|
| Rate for Payer: OMNI Networks Commercial |
$240.10
|
| Rate for Payer: One Health Plan PPO/POS |
$308.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$325.85
|
| Rate for Payer: Three Rivers Provider Network All |
$257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.99
|
| Rate for Payer: Zelis Auto |
$137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$93.64
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 64650
|
| Hospital Charge Code |
6164650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| 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 |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 64650
|
| Hospital Charge Code |
6164650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 64653
|
| Hospital Charge Code |
6164653
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
CHEMODENERV ECCRINE GLANDS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 64653
|
| Hospital Charge Code |
6164653
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| 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 |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
6164611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
6164611
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.00 |
| 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 |
$189.00
|
| 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 |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| 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 |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| 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 |
$299.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| 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 |
$292.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
CHEMODENERV TRUNK MUSC 1-5
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
6164646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$141.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$256.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$99.92
|
|
|
CHEMODENERV TRUNK MUSC 1-5
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
6164646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$141.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$292.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$99.92
|
|
|
CHEMODENERV TRUNK MUSC 6/>
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
6164647
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna Commercial |
$363.80
|
| Rate for Payer: First Health Commercial |
$385.20
|
| Rate for Payer: First Health Workers Compensation |
$165.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$385.20
|
| Rate for Payer: GEHA Commercial |
$342.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$385.20
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$389.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$299.60
|
| Rate for Payer: One Health Plan PPO/POS |
$385.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$406.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$321.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$171.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$116.84
|
|
