|
INCENTIVE SPIROMETER
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
4000709
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$26.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$88.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
INC FOR VAGUS N ELECT IMPL
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 64568
|
| Hospital Charge Code |
6164568
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$376.47 |
| Max. Negotiated Rate |
$57,871.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33,476.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33,476.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26,520.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28,935.89
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$1,172.15
|
| Rate for Payer: First Health Commercial |
$1,241.10
|
| Rate for Payer: First Health Workers Compensation |
$532.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,241.10
|
| Rate for Payer: GEHA Commercial |
$1,103.20
|
| Rate for Payer: GEHA Medicare |
$28,935.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,241.10
|
| Rate for Payer: Humana ChoiceCare |
$31,829.48
|
| Rate for Payer: Humana Medicare Advantage |
$28,935.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$48,612.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27,060.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28,935.89
|
| Rate for Payer: Multiplan All |
$1,254.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49,191.01
|
| Rate for Payer: OMNI Networks Commercial |
$965.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,241.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31,244.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27,060.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28,935.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,310.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$57,871.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,034.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28,357.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27,060.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,935.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,282.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28,935.89
|
| Rate for Payer: Zelis Auto |
$551.60
|
| Rate for Payer: Zelis Medicare |
$24,595.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34,723.07
|
| Rate for Payer: Zelis Worker's Compensation |
$376.47
|
|
|
INC FOR VAGUS N ELECT IMPL
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 64568
|
| Hospital Charge Code |
6164568
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$376.47 |
| Max. Negotiated Rate |
$1,310.05 |
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$1,172.15
|
| Rate for Payer: First Health Commercial |
$1,241.10
|
| Rate for Payer: First Health Workers Compensation |
$532.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,241.10
|
| Rate for Payer: GEHA Commercial |
$965.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,241.10
|
| Rate for Payer: Multiplan All |
$1,254.89
|
| Rate for Payer: OMNI Networks Commercial |
$965.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,241.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,310.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,034.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,282.47
|
| Rate for Payer: Zelis Auto |
$551.60
|
| Rate for Payer: Zelis Worker's Compensation |
$376.47
|
|
|
INCI DEBRIDEMENT PER SESSION 20CM- LESS
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
6193002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$28.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
INCI DEBRIDEMENT PER SESSION 20CM- LESS
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
6193002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$28.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
INCISE BILE DUCT SPHINCTER
|
Facility
|
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 47460
|
| Hospital Charge Code |
6147460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$658.25 |
| Max. Negotiated Rate |
$2,501.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,579.80
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$2,238.05
|
| Rate for Payer: First Health Commercial |
$2,369.70
|
| Rate for Payer: First Health Workers Compensation |
$1,016.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,369.70
|
| Rate for Payer: GEHA Commercial |
$2,106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,369.70
|
| Rate for Payer: Humana ChoiceCare |
$684.58
|
| Rate for Payer: Multiplan All |
$2,396.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,579.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,843.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,369.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,501.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,974.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,317.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$658.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,448.69
|
| Rate for Payer: Zelis Auto |
$1,053.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,316.50
|
| Rate for Payer: Zelis Worker's Compensation |
$718.81
|
|
|
INCISE BILE DUCT SPHINCTER
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 47460
|
| Hospital Charge Code |
6147460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$718.81 |
| Max. Negotiated Rate |
$2,501.35 |
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$2,238.05
|
| Rate for Payer: First Health Commercial |
$2,369.70
|
| Rate for Payer: First Health Workers Compensation |
$1,016.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,369.70
|
| Rate for Payer: GEHA Commercial |
$1,843.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,369.70
|
| Rate for Payer: Multiplan All |
$2,396.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,843.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,369.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,501.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,974.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,448.69
|
| Rate for Payer: Zelis Auto |
$1,053.20
|
| Rate for Payer: Zelis Worker's Compensation |
$718.81
|
|
|
INCISE BLADDER/DRAIN URETER
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
6151045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.73 |
| Max. Negotiated Rate |
$959.50 |
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$707.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Worker's Compensation |
$275.73
|
|
|
INCISE BLADDER/DRAIN URETER
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
6151045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.73 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$606.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$808.00
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$919.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$939.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$404.00
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$275.73
|
|
|
INCISE DIAPHRAGM NERVE
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 64746
|
| Hospital Charge Code |
6164746
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$795.60
|
| Rate for Payer: First Health Commercial |
$842.40
|
| Rate for Payer: First Health Workers Compensation |
$361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$842.40
|
| Rate for Payer: GEHA Commercial |
$655.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$842.40
|
| Rate for Payer: Multiplan All |
$851.76
|
| Rate for Payer: OMNI Networks Commercial |
$655.20
|
| Rate for Payer: One Health Plan PPO/POS |
$842.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$889.20
|
| Rate for Payer: Three Rivers Provider Network All |
$702.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$870.48
|
| Rate for Payer: Zelis Auto |
$374.40
|
| Rate for Payer: Zelis Worker's Compensation |
$255.53
|
|
|
INCISE DIAPHRAGM NERVE
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 64746
|
| Hospital Charge Code |
6164746
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$795.60
|
| Rate for Payer: First Health Commercial |
$842.40
|
| Rate for Payer: First Health Workers Compensation |
$361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$842.40
|
| Rate for Payer: GEHA Commercial |
$748.80
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$842.40
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$851.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$655.20
|
| Rate for Payer: One Health Plan PPO/POS |
$842.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$889.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$702.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$870.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$374.40
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$255.53
|
|
|
INCISE & DRAIN BLADDER
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
6151040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.47 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$442.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$627.30
|
| Rate for Payer: First Health Commercial |
$664.20
|
| Rate for Payer: First Health Workers Compensation |
$284.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$664.20
|
| Rate for Payer: GEHA Commercial |
$590.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$664.20
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$671.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$516.60
|
| Rate for Payer: One Health Plan PPO/POS |
$664.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$701.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$553.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$686.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$295.20
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$201.47
|
|
|
INCISE & DRAIN BLADDER
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
6151040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.47 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$627.30
|
| Rate for Payer: First Health Commercial |
$664.20
|
| Rate for Payer: First Health Workers Compensation |
$284.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$664.20
|
| Rate for Payer: GEHA Commercial |
$516.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$664.20
|
| Rate for Payer: Multiplan All |
$671.58
|
| Rate for Payer: OMNI Networks Commercial |
$516.60
|
| Rate for Payer: One Health Plan PPO/POS |
$664.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$701.10
|
| Rate for Payer: Three Rivers Provider Network All |
$553.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$686.34
|
| Rate for Payer: Zelis Auto |
$295.20
|
| Rate for Payer: Zelis Worker's Compensation |
$201.47
|
|
|
INCISE FINGER TENDON SHEATH
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
6126055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$697.50
|
| Rate for Payer: First Health Workers Compensation |
$299.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$697.50
|
| Rate for Payer: GEHA Commercial |
$542.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$697.50
|
| Rate for Payer: Multiplan All |
$705.25
|
| Rate for Payer: OMNI Networks Commercial |
$542.50
|
| Rate for Payer: One Health Plan PPO/POS |
$697.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$736.25
|
| Rate for Payer: Three Rivers Provider Network All |
$581.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$720.75
|
| Rate for Payer: Zelis Auto |
$310.00
|
| Rate for Payer: Zelis Worker's Compensation |
$211.57
|
|
|
INCISE FINGER TENDON SHEATH
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
6126055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$697.50
|
| Rate for Payer: First Health Workers Compensation |
$299.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$697.50
|
| Rate for Payer: GEHA Commercial |
$620.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$697.50
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$705.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$542.50
|
| Rate for Payer: One Health Plan PPO/POS |
$697.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$736.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$581.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$720.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$310.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$211.57
|
|
|
INCISE FLEXOR CARPI RADIALIS
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 25001
|
| Hospital Charge Code |
6125001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$602.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
INCISE FLEXOR CARPI RADIALIS
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT 25001
|
| Hospital Charge Code |
6125001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$688.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
INCISE/GRAFT MIDFOOT BONES
|
Facility
|
OP
|
$1,368.00
|
|
|
Service Code
|
CPT 28305
|
| Hospital Charge Code |
6128305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.46 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna Commercial |
$1,162.80
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: First Health Workers Compensation |
$528.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,231.20
|
| Rate for Payer: GEHA Commercial |
$1,094.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,231.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,244.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$957.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,231.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,299.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,272.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$547.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$373.46
|
|
|
INCISE/GRAFT MIDFOOT BONES
|
Facility
|
IP
|
$1,368.00
|
|
|
Service Code
|
CPT 28305
|
| Hospital Charge Code |
6128305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.46 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna Commercial |
$1,162.80
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: First Health Workers Compensation |
$528.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,231.20
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,231.20
|
| Rate for Payer: Multiplan All |
$1,244.88
|
| Rate for Payer: OMNI Networks Commercial |
$957.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,231.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,299.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,272.24
|
| Rate for Payer: Zelis Auto |
$547.20
|
| Rate for Payer: Zelis Worker's Compensation |
$373.46
|
|
|
INCISE HAND/FINGER TENDON
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 26460
|
| Hospital Charge Code |
6126460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
INCISE HAND/FINGER TENDON
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 26460
|
| Hospital Charge Code |
6126460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
INCISE HIP/THIGH NERVE
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 64763
|
| Hospital Charge Code |
6164763
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.38 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$629.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: First Health Commercial |
$944.10
|
| Rate for Payer: First Health Workers Compensation |
$405.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$944.10
|
| Rate for Payer: GEHA Commercial |
$839.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$944.10
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$954.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$734.30
|
| Rate for Payer: One Health Plan PPO/POS |
$944.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$996.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$786.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$975.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$419.60
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$286.38
|
|
|
INCISE HIP/THIGH NERVE
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 64766
|
| Hospital Charge Code |
6164766
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.43 |
| Max. Negotiated Rate |
$1,174.20 |
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$477.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$865.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Worker's Compensation |
$337.43
|
|
|
INCISE HIP/THIGH NERVE
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 64766
|
| Hospital Charge Code |
6164766
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.43 |
| Max. Negotiated Rate |
$3,769.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$477.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$988.80
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$337.43
|
|
|
INCISE HIP/THIGH NERVE
|
Facility
|
IP
|
$1,049.00
|
|
|
Service Code
|
CPT 64763
|
| Hospital Charge Code |
6164763
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.38 |
| Max. Negotiated Rate |
$996.55 |
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: First Health Commercial |
$944.10
|
| Rate for Payer: First Health Workers Compensation |
$405.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$944.10
|
| Rate for Payer: GEHA Commercial |
$734.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$944.10
|
| Rate for Payer: Multiplan All |
$954.59
|
| Rate for Payer: OMNI Networks Commercial |
$734.30
|
| Rate for Payer: One Health Plan PPO/POS |
$944.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$996.55
|
| Rate for Payer: Three Rivers Provider Network All |
$786.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$975.57
|
| Rate for Payer: Zelis Auto |
$419.60
|
| Rate for Payer: Zelis Worker's Compensation |
$286.38
|
|
