|
INJ CONTRST CYST ASS
|
Facility
|
IP
|
$1,272.00
|
|
| Hospital Charge Code |
2495009
|
|
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
|
|
|
INJ CONTRST CYST ASS
|
Facility
|
OP
|
$1,272.00
|
|
| Hospital Charge Code |
2407201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$763.20
|
| 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 |
$1,017.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Humana ChoiceCare |
$330.72
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$763.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,119.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$636.00
|
| Rate for Payer: Zelis Worker's Compensation |
$347.26
|
|
|
INJ CONTRST CYST ASS
|
Facility
|
OP
|
$1,272.00
|
|
| Hospital Charge Code |
2495009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$763.20
|
| 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 |
$1,017.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Humana ChoiceCare |
$330.72
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$763.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,119.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$636.00
|
| Rate for Payer: Zelis Worker's Compensation |
$347.26
|
|
|
INJCT AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
3704415
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$348.07 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,083.75
|
| Rate for Payer: First Health Commercial |
$1,147.50
|
| Rate for Payer: First Health Workers Compensation |
$492.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,147.50
|
| Rate for Payer: GEHA Commercial |
$892.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,147.50
|
| Rate for Payer: Multiplan All |
$1,160.25
|
| Rate for Payer: OMNI Networks Commercial |
$892.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,147.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,211.25
|
| Rate for Payer: Three Rivers Provider Network All |
$956.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,185.75
|
| Rate for Payer: Zelis Auto |
$510.00
|
| Rate for Payer: Zelis Worker's Compensation |
$348.07
|
|
|
INJCT AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
6164415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$122.40
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$173.40
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: First Health Workers Compensation |
$78.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.60
|
| Rate for Payer: GEHA Commercial |
$163.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$185.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$183.60
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$153.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$81.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$55.69
|
|
|
INJCT AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
6164415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$173.40
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: First Health Workers Compensation |
$78.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.60
|
| Rate for Payer: GEHA Commercial |
$142.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.60
|
| Rate for Payer: Multiplan All |
$185.64
|
| Rate for Payer: OMNI Networks Commercial |
$142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$183.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.72
|
| Rate for Payer: Zelis Auto |
$81.60
|
| Rate for Payer: Zelis Worker's Compensation |
$55.69
|
|
|
INJCT AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
3764415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.13 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$730.80
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$974.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| 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 |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$487.20
|
| 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 |
$769.29
|
|
|
INJCT AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
3764415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$852.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
INJCT AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
3704415
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$298.13 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$765.00
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,083.75
|
| Rate for Payer: First Health Commercial |
$1,147.50
|
| Rate for Payer: First Health Workers Compensation |
$492.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,147.50
|
| Rate for Payer: GEHA Commercial |
$1,020.00
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,147.50
|
| 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 |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$1,160.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$892.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,147.50
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,211.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$956.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,185.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$510.00
|
| 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 |
$348.07
|
|
|
INJ DIHYDROERGOTAMINE MESYLATE 1 MG
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
8501110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$64.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$66.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$43.68
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$100.80
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$147.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.86
|
|
|
INJ DIHYDROERGOTAMINE MESYLATE 1 MG
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
8501110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$64.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$45.86
|
|
|
INJECT AA&/STRD AXILLARY NERVE W/IMG GDN
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
6164417
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.33 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$85.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Worker's Compensation |
$60.33
|
|
|
INJECT AA&/STRD AXILLARY NERVE W/IMG GDN
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
6164417
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.33 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$132.60
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$85.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| 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 |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$60.33
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
3764447
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
7664447
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: First Health Commercial |
$324.00
|
| Rate for Payer: First Health Workers Compensation |
$139.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.00
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.00
|
| Rate for Payer: Multiplan All |
$327.60
|
| Rate for Payer: OMNI Networks Commercial |
$252.00
|
| Rate for Payer: One Health Plan PPO/POS |
$324.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.00
|
| Rate for Payer: Three Rivers Provider Network All |
$270.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$334.80
|
| Rate for Payer: Zelis Auto |
$144.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.28
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
7664447
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.28 |
| 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 |
$216.00
|
| 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 |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: First Health Commercial |
$324.00
|
| Rate for Payer: First Health Workers Compensation |
$139.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.00
|
| Rate for Payer: GEHA Commercial |
$288.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.00
|
| 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 |
$327.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$252.00
|
| Rate for Payer: One Health Plan PPO/POS |
$324.00
|
| 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 |
$342.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$270.00
|
| 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 |
$334.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$144.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$98.28
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
6164447
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.28 |
| 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 |
$216.00
|
| 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 |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: First Health Commercial |
$324.00
|
| Rate for Payer: First Health Workers Compensation |
$139.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.00
|
| Rate for Payer: GEHA Commercial |
$288.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.00
|
| 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 |
$327.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$252.00
|
| Rate for Payer: One Health Plan PPO/POS |
$324.00
|
| 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 |
$342.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$270.00
|
| 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 |
$334.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$144.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$98.28
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
3704447
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
6164447
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: First Health Commercial |
$324.00
|
| Rate for Payer: First Health Workers Compensation |
$139.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.00
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.00
|
| Rate for Payer: Multiplan All |
$327.60
|
| Rate for Payer: OMNI Networks Commercial |
$252.00
|
| Rate for Payer: One Health Plan PPO/POS |
$324.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.00
|
| Rate for Payer: Three Rivers Provider Network All |
$270.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$334.80
|
| Rate for Payer: Zelis Auto |
$144.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.28
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
3764447
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$263.17 |
| 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 |
$578.40
|
| 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 |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| 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 |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| 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 |
$915.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| 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 |
$896.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
INJECT AA&/STRD FEMORAL NERVE W/IMG GDN
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
3704447
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$263.17 |
| 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 |
$578.40
|
| 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 |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| 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 |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| 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 |
$915.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| 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 |
$896.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
INJECT AA&/STRD SCIATIC NERVE W/IMG GDN
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
7664445
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
INJECT AA&/STRD SCIATIC NERVE W/IMG GDN
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
6164445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
INJECT AA&/STRD SCIATIC NERVE W/IMG GDN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
6164445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$1,315.16 |
| 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 |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
INJECT AA&/STRD SCIATIC NERVE W/IMG GDN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
7664445
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$1,315.16 |
| 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 |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
