|
drug screen 5rflx conf,meconiumREF809373
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
drug screen 5rflx conf,meconiumREF809373
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
OP
|
$6,210.00
|
|
| Hospital Charge Code |
8146922
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$5,899.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,726.00
|
| Rate for Payer: Cash Price |
$3,726.00
|
| Rate for Payer: Cigna Commercial |
$5,278.50
|
| Rate for Payer: First Health Commercial |
$5,589.00
|
| Rate for Payer: First Health Workers Compensation |
$2,397.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,589.00
|
| Rate for Payer: GEHA Commercial |
$4,968.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,589.00
|
| Rate for Payer: Humana ChoiceCare |
$1,614.60
|
| Rate for Payer: Multiplan All |
$5,651.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,726.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,347.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,589.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,899.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,657.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,464.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,552.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,775.30
|
| Rate for Payer: Zelis Auto |
$2,484.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,105.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,695.33
|
|
|
DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Facility
|
IP
|
$6,210.00
|
|
| Hospital Charge Code |
8146922
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,695.33 |
| Max. Negotiated Rate |
$5,899.50 |
| Rate for Payer: Cash Price |
$3,726.00
|
| Rate for Payer: Cigna Commercial |
$5,278.50
|
| Rate for Payer: First Health Commercial |
$5,589.00
|
| Rate for Payer: First Health Workers Compensation |
$2,397.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,589.00
|
| Rate for Payer: GEHA Commercial |
$4,347.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,589.00
|
| Rate for Payer: Multiplan All |
$5,651.10
|
| Rate for Payer: OMNI Networks Commercial |
$4,347.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,589.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,899.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,657.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,775.30
|
| Rate for Payer: Zelis Auto |
$2,484.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,695.33
|
|
|
DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
20300079
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
20300079
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
6154050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
6154050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
7664640
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
7664640
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
21764640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
6164640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$171.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$243.10
|
| Rate for Payer: First Health Commercial |
$257.40
|
| Rate for Payer: First Health Workers Compensation |
$110.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$257.40
|
| Rate for Payer: GEHA Commercial |
$228.80
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$257.40
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$260.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$200.20
|
| Rate for Payer: One Health Plan PPO/POS |
$257.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$271.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$214.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$114.40
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$78.08
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
6164640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$243.10
|
| Rate for Payer: First Health Commercial |
$257.40
|
| Rate for Payer: First Health Workers Compensation |
$110.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$257.40
|
| Rate for Payer: GEHA Commercial |
$200.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$257.40
|
| Rate for Payer: Multiplan All |
$260.26
|
| Rate for Payer: OMNI Networks Commercial |
$200.20
|
| Rate for Payer: One Health Plan PPO/POS |
$257.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$271.70
|
| Rate for Payer: Three Rivers Provider Network All |
$214.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.98
|
| Rate for Payer: Zelis Auto |
$114.40
|
| Rate for Payer: Zelis Worker's Compensation |
$78.08
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
21764640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
21900158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DSTRJ NEUROLYTIC AGNT OTHER PERIPH NERV
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
21900158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL C/T
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
7664634
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL C/T
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
6164634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL C/T
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
6164634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$263.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$263.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.05
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.30
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$246.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL C/T
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
7664634
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$263.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$263.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$209.05
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$213.30
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$246.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL L/S
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
6164636
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$71.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$50.78
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL L/S
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
7664636
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$71.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$50.78
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL L/S
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
7664636
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$755.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$755.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$755.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$598.15
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$71.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$48.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$610.34
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$111.60
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$704.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$610.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$163.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$610.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$93.00
|
| Rate for Payer: Zelis Worker's Compensation |
$50.78
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT ADDL L/S
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
6164636
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$755.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$755.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$755.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$598.15
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$71.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$48.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$610.34
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$111.60
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$704.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$610.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$163.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$610.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$93.00
|
| Rate for Payer: Zelis Worker's Compensation |
$50.78
|
|
|
DSTR NROLYTC AGNT PARVERTEB FCT SNGL C/T
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
6164633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$267.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$485.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: Zelis Auto |
$277.60
|
| Rate for Payer: Zelis Worker's Compensation |
$189.46
|
|
