|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$1,624.00
|
|
| Hospital Charge Code |
8164450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$627.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,299.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Humana ChoiceCare |
$422.24
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$974.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,429.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$406.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$812.00
|
| Rate for Payer: Zelis Worker's Compensation |
$443.35
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$204.09
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
7264450
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$193.89 |
| Rate for Payer: Cash Price |
$122.45
|
| Rate for Payer: Cigna Commercial |
$173.48
|
| Rate for Payer: First Health Commercial |
$183.68
|
| Rate for Payer: First Health Workers Compensation |
$78.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.68
|
| Rate for Payer: GEHA Commercial |
$142.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.68
|
| Rate for Payer: Multiplan All |
$185.72
|
| Rate for Payer: OMNI Networks Commercial |
$142.86
|
| Rate for Payer: One Health Plan PPO/POS |
$183.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.89
|
| Rate for Payer: Three Rivers Provider Network All |
$153.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.80
|
| Rate for Payer: Zelis Auto |
$81.64
|
| Rate for Payer: Zelis Worker's Compensation |
$55.72
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$2,862.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9664450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$781.33 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Cash Price |
$1,717.20
|
| Rate for Payer: Cigna Commercial |
$2,432.70
|
| Rate for Payer: First Health Commercial |
$2,575.80
|
| Rate for Payer: First Health Workers Compensation |
$1,105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,575.80
|
| Rate for Payer: GEHA Commercial |
$2,003.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,575.80
|
| Rate for Payer: Multiplan All |
$2,604.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,003.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,575.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,718.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,146.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,661.66
|
| Rate for Payer: Zelis Auto |
$1,144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$781.33
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8300052
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9664450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.13 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,717.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$1,717.20
|
| Rate for Payer: Cash Price |
$1,717.20
|
| Rate for Payer: Cigna Commercial |
$2,432.70
|
| Rate for Payer: First Health Commercial |
$2,575.80
|
| Rate for Payer: First Health Workers Compensation |
$1,105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,575.80
|
| Rate for Payer: GEHA Commercial |
$2,289.60
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,575.80
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$2,604.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,003.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,575.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,718.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,146.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,661.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$1,144.80
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$781.33
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8764450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$204.09
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8564450
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$193.89 |
| Rate for Payer: Cash Price |
$122.45
|
| Rate for Payer: Cigna Commercial |
$173.48
|
| Rate for Payer: First Health Commercial |
$183.68
|
| Rate for Payer: First Health Workers Compensation |
$78.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.68
|
| Rate for Payer: GEHA Commercial |
$142.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.68
|
| Rate for Payer: Multiplan All |
$185.72
|
| Rate for Payer: OMNI Networks Commercial |
$142.86
|
| Rate for Payer: One Health Plan PPO/POS |
$183.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.89
|
| Rate for Payer: Three Rivers Provider Network All |
$153.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.80
|
| Rate for Payer: Zelis Auto |
$81.64
|
| Rate for Payer: Zelis Worker's Compensation |
$55.72
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20300039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$204.09
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
7264450
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$122.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$122.45
|
| Rate for Payer: Cash Price |
$122.45
|
| Rate for Payer: Cigna Commercial |
$173.48
|
| Rate for Payer: First Health Commercial |
$183.68
|
| Rate for Payer: First Health Workers Compensation |
$78.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.68
|
| Rate for Payer: GEHA Commercial |
$163.27
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.68
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$185.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$142.86
|
| Rate for Payer: One Health Plan PPO/POS |
$183.68
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$153.07
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$81.64
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$55.72
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
7664450
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$1,624.00
|
|
| Hospital Charge Code |
8164450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$627.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Worker's Compensation |
$443.35
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
1900039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$793.07 |
| Max. Negotiated Rate |
$2,759.75 |
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,614.50
|
| Rate for Payer: First Health Workers Compensation |
$1,121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,614.50
|
| Rate for Payer: GEHA Commercial |
$2,033.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,614.50
|
| Rate for Payer: Multiplan All |
$2,643.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,033.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,614.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,759.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,178.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,701.65
|
| Rate for Payer: Zelis Auto |
$1,162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$793.07
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6164450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20300039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8300052
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
21600147
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8764450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$204.09
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
8564450
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$122.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$122.45
|
| Rate for Payer: Cash Price |
$122.45
|
| Rate for Payer: Cigna Commercial |
$173.48
|
| Rate for Payer: First Health Commercial |
$183.68
|
| Rate for Payer: First Health Workers Compensation |
$78.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.68
|
| Rate for Payer: GEHA Commercial |
$163.27
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.68
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$185.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$142.86
|
| Rate for Payer: One Health Plan PPO/POS |
$183.68
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$153.07
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$81.64
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$55.72
|
|
|
INJ AA&/STRD SCIATIC NERVE CONT NFS CATH
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
6164446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.70 |
| 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 |
$148.80
|
| 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 |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| 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 |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| 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 |
$235.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| 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 |
$230.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$99.20
|
| 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 |
$67.70
|
|
|
INJ AA&/STRD SCIATIC NERVE CONT NFS CATH
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
6164446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
INJ ANE PERIPH NRV/BRANCH
|
Facility
|
IP
|
$438.00
|
|
| Hospital Charge Code |
8165210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
INJ ANE PERIPH NRV/BRANCH
|
Facility
|
OP
|
$438.00
|
|
| Hospital Charge Code |
8165210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$350.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Humana ChoiceCare |
$113.88
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$262.80
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$385.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$219.00
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
INJ COLLAGENASE CHC 0.01 MG
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT J0775
|
| Hospital Charge Code |
8500775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
INJ COLLAGENASE CHC 0.01 MG
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT J0775
|
| Hospital Charge Code |
8500775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$75.91
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$83.50
|
| Rate for Payer: GEHA Medicare |
$75.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$83.50
|
| Rate for Payer: Humana Medicare Advantage |
$75.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$127.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$75.91
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.05
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$53.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$75.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$151.82
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$74.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$75.91
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$64.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.09
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
INJ CONTRST CYST ASS
|
Facility
|
IP
|
$1,272.00
|
|
| Hospital Charge Code |
2407201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$347.26 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$1,081.20
|
| Rate for Payer: First Health Commercial |
$1,144.80
|
| Rate for Payer: First Health Workers Compensation |
$491.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,144.80
|
| Rate for Payer: GEHA Commercial |
$890.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: OMNI Networks Commercial |
$890.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,144.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,208.40
|
| Rate for Payer: Three Rivers Provider Network All |
$954.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
| Rate for Payer: Zelis Worker's Compensation |
$347.26
|
|
