|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$3,383.00
|
|
|
Service Code
|
CPT 61860
|
| Hospital Charge Code |
6161860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$923.56 |
| Max. Negotiated Rate |
$3,213.85 |
| Rate for Payer: Cash Price |
$2,029.80
|
| Rate for Payer: Cigna Commercial |
$2,875.55
|
| Rate for Payer: First Health Commercial |
$3,044.70
|
| Rate for Payer: First Health Workers Compensation |
$1,306.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,044.70
|
| Rate for Payer: GEHA Commercial |
$2,368.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,044.70
|
| Rate for Payer: Multiplan All |
$3,078.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,368.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,044.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,213.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,537.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,146.19
|
| Rate for Payer: Zelis Auto |
$1,353.20
|
| Rate for Payer: Zelis Worker's Compensation |
$923.56
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 63655
|
| Hospital Charge Code |
6163655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.47 |
| Max. Negotiated Rate |
$41,558.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,747.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,042.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,747.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,929.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20,779.19
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: First Health Commercial |
$1,564.20
|
| Rate for Payer: First Health Workers Compensation |
$671.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,564.20
|
| Rate for Payer: GEHA Commercial |
$1,390.40
|
| Rate for Payer: GEHA Medicare |
$20,779.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,564.20
|
| Rate for Payer: Humana ChoiceCare |
$22,857.11
|
| Rate for Payer: Humana Medicare Advantage |
$20,779.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34,909.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,071.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20,779.19
|
| Rate for Payer: Multiplan All |
$1,581.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35,324.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,216.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,564.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,164.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,071.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20,779.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,651.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41,558.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,303.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20,363.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,071.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,779.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,616.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20,779.19
|
| Rate for Payer: Zelis Auto |
$695.20
|
| Rate for Payer: Zelis Medicare |
$17,662.31
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24,935.03
|
| Rate for Payer: Zelis Worker's Compensation |
$474.47
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$5,482.92
|
|
|
Service Code
|
CPT 64555
|
| Hospital Charge Code |
6164555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,496.84 |
| Max. Negotiated Rate |
$5,208.77 |
| Rate for Payer: Cash Price |
$3,289.75
|
| Rate for Payer: Cigna Commercial |
$4,660.48
|
| Rate for Payer: First Health Commercial |
$4,934.63
|
| Rate for Payer: First Health Workers Compensation |
$2,116.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,934.63
|
| Rate for Payer: GEHA Commercial |
$3,838.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,934.63
|
| Rate for Payer: Multiplan All |
$4,989.46
|
| Rate for Payer: OMNI Networks Commercial |
$3,838.04
|
| Rate for Payer: One Health Plan PPO/POS |
$4,934.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,208.77
|
| Rate for Payer: Three Rivers Provider Network All |
$4,112.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,099.12
|
| Rate for Payer: Zelis Auto |
$2,193.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,496.84
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$5,482.92
|
|
|
Service Code
|
CPT 64555
|
| Hospital Charge Code |
6164555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,496.84 |
| Max. Negotiated Rate |
$12,718.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,289.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,263.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,359.32
|
| Rate for Payer: Cash Price |
$3,289.75
|
| Rate for Payer: Cash Price |
$3,289.75
|
| Rate for Payer: Cigna Commercial |
$4,660.48
|
| Rate for Payer: First Health Commercial |
$4,934.63
|
| Rate for Payer: First Health Workers Compensation |
$2,116.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,934.63
|
| Rate for Payer: GEHA Commercial |
$4,386.34
|
| Rate for Payer: GEHA Medicare |
$6,359.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,934.63
|
| Rate for Payer: Humana ChoiceCare |
$6,995.25
|
| Rate for Payer: Humana Medicare Advantage |
$6,359.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,683.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,370.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,359.32
|
| Rate for Payer: Multiplan All |
$4,989.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,810.84
|
| Rate for Payer: OMNI Networks Commercial |
$3,838.04
|
| Rate for Payer: One Health Plan PPO/POS |
$4,934.63
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,200.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,370.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,359.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,208.77
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,718.64
|
| Rate for Payer: Three Rivers Provider Network All |
$4,112.19
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,232.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,370.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,359.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,099.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,359.32
|
| Rate for Payer: Zelis Auto |
$2,193.17
|
| Rate for Payer: Zelis Medicare |
$5,405.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,631.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,496.84
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 64581
|
| Hospital Charge Code |
6164581
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.01 |
| Max. Negotiated Rate |
$12,718.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,747.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$822.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,747.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,929.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,359.32
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cigna Commercial |
$1,164.50
|
| Rate for Payer: First Health Commercial |
$1,233.00
|
| Rate for Payer: First Health Workers Compensation |
$528.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.00
|
| Rate for Payer: GEHA Commercial |
$1,096.00
|
| Rate for Payer: GEHA Medicare |
$6,359.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.00
|
| Rate for Payer: Humana ChoiceCare |
$6,995.25
|
| Rate for Payer: Humana Medicare Advantage |
$6,359.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,683.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,071.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,359.32
|
| Rate for Payer: Multiplan All |
$1,246.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,810.84
|
| Rate for Payer: OMNI Networks Commercial |
$959.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,164.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,071.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,359.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,718.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,232.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,071.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,359.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,274.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,359.32
|
| Rate for Payer: Zelis Auto |
$548.00
|
| Rate for Payer: Zelis Medicare |
$5,405.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,631.18
|
| Rate for Payer: Zelis Worker's Compensation |
$374.01
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
6163650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.71 |
| Max. Negotiated Rate |
$1,216.95 |
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: First Health Workers Compensation |
$494.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$896.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: Zelis Auto |
$512.40
|
| Rate for Payer: Zelis Worker's Compensation |
$349.71
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 64575
|
| Hospital Charge Code |
6164575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$24,166.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,083.48
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$696.15
|
| Rate for Payer: First Health Commercial |
$737.10
|
| Rate for Payer: First Health Workers Compensation |
$316.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$737.10
|
| Rate for Payer: GEHA Commercial |
$655.20
|
| Rate for Payer: GEHA Medicare |
$12,083.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| Rate for Payer: Humana ChoiceCare |
$13,291.83
|
| Rate for Payer: Humana Medicare Advantage |
$12,083.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,300.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,083.48
|
| Rate for Payer: Multiplan All |
$745.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,541.92
|
| Rate for Payer: OMNI Networks Commercial |
$573.30
|
| Rate for Payer: One Health Plan PPO/POS |
$737.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,083.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$778.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,166.96
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,841.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$204.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,083.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$761.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,083.48
|
| Rate for Payer: Zelis Auto |
$327.60
|
| Rate for Payer: Zelis Medicare |
$10,270.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,500.18
|
| Rate for Payer: Zelis Worker's Compensation |
$223.59
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
CPT 61870
|
| Hospital Charge Code |
6161870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$666.12 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cigna Commercial |
$2,074.00
|
| Rate for Payer: First Health Commercial |
$2,196.00
|
| Rate for Payer: First Health Workers Compensation |
$942.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,196.00
|
| Rate for Payer: GEHA Commercial |
$1,708.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,196.00
|
| Rate for Payer: Multiplan All |
$2,220.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,708.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,318.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,830.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,269.20
|
| Rate for Payer: Zelis Auto |
$976.00
|
| Rate for Payer: Zelis Worker's Compensation |
$666.12
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 64553
|
| Hospital Charge Code |
6164553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.76 |
| Max. Negotiated Rate |
$1,053.55 |
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cigna Commercial |
$942.65
|
| Rate for Payer: First Health Commercial |
$998.10
|
| Rate for Payer: First Health Workers Compensation |
$428.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$998.10
|
| Rate for Payer: GEHA Commercial |
$776.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$998.10
|
| Rate for Payer: Multiplan All |
$1,009.19
|
| Rate for Payer: OMNI Networks Commercial |
$776.30
|
| Rate for Payer: One Health Plan PPO/POS |
$998.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,053.55
|
| Rate for Payer: Three Rivers Provider Network All |
$831.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,031.37
|
| Rate for Payer: Zelis Auto |
$443.60
|
| Rate for Payer: Zelis Worker's Compensation |
$302.76
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 64580
|
| Hospital Charge Code |
6164580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$213.49 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: First Health Workers Compensation |
$301.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$547.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: Zelis Auto |
$312.80
|
| Rate for Payer: Zelis Worker's Compensation |
$213.49
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 64553
|
| Hospital Charge Code |
6164553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.76 |
| Max. Negotiated Rate |
$24,166.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$665.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,263.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,083.48
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cigna Commercial |
$942.65
|
| Rate for Payer: First Health Commercial |
$998.10
|
| Rate for Payer: First Health Workers Compensation |
$428.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$998.10
|
| Rate for Payer: GEHA Commercial |
$887.20
|
| Rate for Payer: GEHA Medicare |
$12,083.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$998.10
|
| Rate for Payer: Humana ChoiceCare |
$13,291.83
|
| Rate for Payer: Humana Medicare Advantage |
$12,083.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,300.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,370.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,083.48
|
| Rate for Payer: Multiplan All |
$1,009.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,541.92
|
| Rate for Payer: OMNI Networks Commercial |
$776.30
|
| Rate for Payer: One Health Plan PPO/POS |
$998.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,200.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,370.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,083.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,053.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,166.96
|
| Rate for Payer: Three Rivers Provider Network All |
$831.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,841.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,370.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,083.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,031.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,083.48
|
| Rate for Payer: Zelis Auto |
$443.60
|
| Rate for Payer: Zelis Medicare |
$10,270.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,500.18
|
| Rate for Payer: Zelis Worker's Compensation |
$302.76
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 64580
|
| Hospital Charge Code |
6164580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$213.49 |
| Max. Negotiated Rate |
$41,558.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,747.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$469.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,747.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,929.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20,779.19
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: First Health Workers Compensation |
$301.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$625.60
|
| Rate for Payer: GEHA Medicare |
$20,779.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Humana ChoiceCare |
$22,857.11
|
| Rate for Payer: Humana Medicare Advantage |
$20,779.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34,909.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,071.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20,779.19
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35,324.62
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,164.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,071.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20,779.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41,558.38
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20,363.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,071.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,779.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20,779.19
|
| Rate for Payer: Zelis Auto |
$312.80
|
| Rate for Payer: Zelis Medicare |
$17,662.31
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24,935.03
|
| Rate for Payer: Zelis Worker's Compensation |
$213.49
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 64575
|
| Hospital Charge Code |
6164575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.59 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$696.15
|
| Rate for Payer: First Health Commercial |
$737.10
|
| Rate for Payer: First Health Workers Compensation |
$316.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$737.10
|
| Rate for Payer: GEHA Commercial |
$573.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| Rate for Payer: Multiplan All |
$745.29
|
| Rate for Payer: OMNI Networks Commercial |
$573.30
|
| Rate for Payer: One Health Plan PPO/POS |
$737.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$778.05
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$761.67
|
| Rate for Payer: Zelis Auto |
$327.60
|
| Rate for Payer: Zelis Worker's Compensation |
$223.59
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
CPT 61870
|
| Hospital Charge Code |
6161870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cigna Commercial |
$2,074.00
|
| Rate for Payer: First Health Commercial |
$2,196.00
|
| Rate for Payer: First Health Workers Compensation |
$942.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,196.00
|
| Rate for Payer: GEHA Commercial |
$1,952.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,196.00
|
| Rate for Payer: Humana ChoiceCare |
$634.40
|
| Rate for Payer: Multiplan All |
$2,220.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,464.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,708.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,318.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,830.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,147.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$610.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,269.20
|
| Rate for Payer: Zelis Auto |
$976.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,220.00
|
| Rate for Payer: Zelis Worker's Compensation |
$666.12
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 61850
|
| Hospital Charge Code |
6161850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$527.50 |
| Max. Negotiated Rate |
$2,004.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,266.00
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$1,793.50
|
| Rate for Payer: First Health Commercial |
$1,899.00
|
| Rate for Payer: First Health Workers Compensation |
$814.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,899.00
|
| Rate for Payer: GEHA Commercial |
$1,688.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,899.00
|
| Rate for Payer: Humana ChoiceCare |
$548.60
|
| Rate for Payer: Multiplan All |
$1,920.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,266.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,477.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,899.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,004.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,582.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,856.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$527.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,962.30
|
| Rate for Payer: Zelis Auto |
$844.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,055.00
|
| Rate for Payer: Zelis Worker's Compensation |
$576.03
|
|
|
IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 63655
|
| Hospital Charge Code |
6163655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.47 |
| Max. Negotiated Rate |
$1,651.10 |
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: First Health Commercial |
$1,564.20
|
| Rate for Payer: First Health Workers Compensation |
$671.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,564.20
|
| Rate for Payer: GEHA Commercial |
$1,216.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,564.20
|
| Rate for Payer: Multiplan All |
$1,581.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,216.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,564.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,651.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,303.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,616.34
|
| Rate for Payer: Zelis Auto |
$695.20
|
| Rate for Payer: Zelis Worker's Compensation |
$474.47
|
|
|
IMPLANT NEUROSTIM ARRAYS
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 61886
|
| Hospital Charge Code |
6161886
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.39 |
| Max. Negotiated Rate |
$1,689.10 |
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$1,511.30
|
| Rate for Payer: First Health Commercial |
$1,600.20
|
| Rate for Payer: First Health Workers Compensation |
$686.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,600.20
|
| Rate for Payer: GEHA Commercial |
$1,244.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,600.20
|
| Rate for Payer: Multiplan All |
$1,617.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,244.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,600.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,689.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,333.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,653.54
|
| Rate for Payer: Zelis Auto |
$711.20
|
| Rate for Payer: Zelis Worker's Compensation |
$485.39
|
|
|
IMPLANT NEUROSTIM ARRAYS
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 61886
|
| Hospital Charge Code |
6161886
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.39 |
| Max. Negotiated Rate |
$59,056.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27,778.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,066.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27,778.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22,006.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29,528.30
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$1,511.30
|
| Rate for Payer: First Health Commercial |
$1,600.20
|
| Rate for Payer: First Health Workers Compensation |
$686.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,600.20
|
| Rate for Payer: GEHA Commercial |
$1,422.40
|
| Rate for Payer: GEHA Medicare |
$29,528.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,600.20
|
| Rate for Payer: Humana ChoiceCare |
$32,481.13
|
| Rate for Payer: Humana Medicare Advantage |
$29,528.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49,607.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22,454.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29,528.30
|
| Rate for Payer: Multiplan All |
$1,617.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50,198.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,244.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,600.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25,926.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22,454.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29,528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,689.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59,056.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,333.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28,937.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22,454.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,528.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,653.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29,528.30
|
| Rate for Payer: Zelis Auto |
$711.20
|
| Rate for Payer: Zelis Medicare |
$25,099.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35,433.96
|
| Rate for Payer: Zelis Worker's Compensation |
$485.39
|
|
|
IMPLANT PLATE OLECRONON
|
Facility
|
OP
|
$3,493.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.25 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,095.80
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cigna Commercial |
$2,969.05
|
| Rate for Payer: First Health Commercial |
$3,143.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,143.70
|
| Rate for Payer: GEHA Commercial |
$2,794.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,143.70
|
| Rate for Payer: Humana ChoiceCare |
$908.18
|
| Rate for Payer: Multiplan All |
$3,178.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,095.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,445.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,143.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,318.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,619.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,073.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$873.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,248.49
|
| Rate for Payer: Zelis Auto |
$1,397.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,746.50
|
|
|
IMPLANT PLATE OLECRONON
|
Facility
|
IP
|
$3,493.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.20 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,794.40
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cigna Commercial |
$2,969.05
|
| Rate for Payer: First Health Commercial |
$3,143.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,143.70
|
| Rate for Payer: GEHA Commercial |
$2,445.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,143.70
|
| Rate for Payer: Multiplan All |
$3,178.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,445.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,143.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,318.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,619.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,248.49
|
| Rate for Payer: Zelis Auto |
$1,397.20
|
|
|
IMPLANT RADIAL HEAD 18MM
|
Facility
|
IP
|
$5,550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,220.00 |
| Max. Negotiated Rate |
$5,272.50 |
| Rate for Payer: Zelis Auto |
$2,220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,440.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cigna Commercial |
$4,717.50
|
| Rate for Payer: First Health Commercial |
$4,995.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,995.00
|
| Rate for Payer: GEHA Commercial |
$3,885.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,995.00
|
| Rate for Payer: Multiplan All |
$5,050.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,885.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,995.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,272.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,161.50
|
|
|
IMPLANT RADIAL HEAD 18MM
|
Facility
|
OP
|
$5,550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$5,272.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cigna Commercial |
$4,717.50
|
| Rate for Payer: First Health Commercial |
$4,995.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,995.00
|
| Rate for Payer: GEHA Commercial |
$4,440.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,995.00
|
| Rate for Payer: Humana ChoiceCare |
$1,443.00
|
| Rate for Payer: Multiplan All |
$5,050.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,330.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,885.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,995.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,272.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,162.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,884.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,387.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,161.50
|
| Rate for Payer: Zelis Auto |
$2,220.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,775.00
|
|
|
IMPLANT RADIAL STEM 6.5MM
|
Facility
|
IP
|
$6,350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,540.00 |
| Max. Negotiated Rate |
$6,032.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,080.00
|
| Rate for Payer: Cash Price |
$3,810.00
|
| Rate for Payer: Cash Price |
$3,810.00
|
| Rate for Payer: Cigna Commercial |
$5,397.50
|
| Rate for Payer: First Health Commercial |
$5,715.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,715.00
|
| Rate for Payer: GEHA Commercial |
$4,445.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,715.00
|
| Rate for Payer: Multiplan All |
$5,778.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,445.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,715.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,032.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,762.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,905.50
|
| Rate for Payer: Zelis Auto |
$2,540.00
|
|
|
IMPLANT RADIAL STEM 6.5MM
|
Facility
|
OP
|
$6,350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,587.50 |
| Max. Negotiated Rate |
$6,032.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,810.00
|
| Rate for Payer: Cash Price |
$3,810.00
|
| Rate for Payer: Cash Price |
$3,810.00
|
| Rate for Payer: Cigna Commercial |
$5,397.50
|
| Rate for Payer: First Health Commercial |
$5,715.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,715.00
|
| Rate for Payer: GEHA Commercial |
$5,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,715.00
|
| Rate for Payer: Humana ChoiceCare |
$1,651.00
|
| Rate for Payer: Multiplan All |
$5,778.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,810.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,445.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,715.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,032.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,762.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,588.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,587.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,905.50
|
| Rate for Payer: Zelis Auto |
$2,540.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,175.00
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$1,823.00
|
|
|
Service Code
|
CPT 62351
|
| Hospital Charge Code |
6162351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$497.68 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,977.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,093.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,977.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,942.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,093.80
|
| Rate for Payer: Cigna Commercial |
$1,549.55
|
| Rate for Payer: First Health Commercial |
$1,640.70
|
| Rate for Payer: First Health Workers Compensation |
$703.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,640.70
|
| Rate for Payer: GEHA Commercial |
$1,458.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,640.70
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,023.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,658.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,276.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,640.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,645.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,023.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,731.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,367.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,023.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,695.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$729.20
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$497.68
|
|
