|
INJECTABLE AUGMENT KIT 1.5CC
|
Facility
|
IP
|
$5,901.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.40 |
| Max. Negotiated Rate |
$5,605.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,720.80
|
| Rate for Payer: Cash Price |
$3,540.60
|
| Rate for Payer: Cash Price |
$3,540.60
|
| Rate for Payer: Cigna Commercial |
$5,015.85
|
| Rate for Payer: First Health Commercial |
$5,310.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,310.90
|
| Rate for Payer: GEHA Commercial |
$4,130.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,310.90
|
| Rate for Payer: Multiplan All |
$5,369.91
|
| Rate for Payer: OMNI Networks Commercial |
$4,130.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,310.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,605.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,425.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,487.93
|
| Rate for Payer: Zelis Auto |
$2,360.40
|
|
|
INJECTABLE AUGMENT KIT 1.5CC
|
Facility
|
OP
|
$5,901.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.25 |
| Max. Negotiated Rate |
$5,605.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,540.60
|
| Rate for Payer: Cash Price |
$3,540.60
|
| Rate for Payer: Cash Price |
$3,540.60
|
| Rate for Payer: Cigna Commercial |
$5,015.85
|
| Rate for Payer: First Health Commercial |
$5,310.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,310.90
|
| Rate for Payer: GEHA Commercial |
$4,720.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,310.90
|
| Rate for Payer: Humana ChoiceCare |
$1,534.26
|
| Rate for Payer: Multiplan All |
$5,369.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,540.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,130.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,310.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,605.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,425.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,192.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,475.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,487.93
|
| Rate for Payer: Zelis Auto |
$2,360.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,950.50
|
|
|
INJECTABLE AUGMENT KIT 3.0CC
|
Facility
|
OP
|
$9,903.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.75 |
| Max. Negotiated Rate |
$9,407.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,941.80
|
| Rate for Payer: Cash Price |
$5,941.80
|
| Rate for Payer: Cash Price |
$5,941.80
|
| Rate for Payer: Cigna Commercial |
$8,417.55
|
| Rate for Payer: First Health Commercial |
$8,912.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,912.70
|
| Rate for Payer: GEHA Commercial |
$7,922.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,912.70
|
| Rate for Payer: Humana ChoiceCare |
$2,574.78
|
| Rate for Payer: Multiplan All |
$9,011.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,941.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,932.10
|
| Rate for Payer: One Health Plan PPO/POS |
$8,912.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,407.85
|
| Rate for Payer: Three Rivers Provider Network All |
$7,427.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,714.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,475.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,209.79
|
| Rate for Payer: Zelis Auto |
$3,961.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,951.50
|
|
|
INJECTABLE AUGMENT KIT 3.0CC
|
Facility
|
IP
|
$9,903.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,961.20 |
| Max. Negotiated Rate |
$9,407.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,922.40
|
| Rate for Payer: Cash Price |
$5,941.80
|
| Rate for Payer: Cash Price |
$5,941.80
|
| Rate for Payer: Cigna Commercial |
$8,417.55
|
| Rate for Payer: First Health Commercial |
$8,912.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,912.70
|
| Rate for Payer: GEHA Commercial |
$6,932.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,912.70
|
| Rate for Payer: Multiplan All |
$9,011.73
|
| Rate for Payer: OMNI Networks Commercial |
$6,932.10
|
| Rate for Payer: One Health Plan PPO/POS |
$8,912.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,407.85
|
| Rate for Payer: Three Rivers Provider Network All |
$7,427.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,209.79
|
| Rate for Payer: Zelis Auto |
$3,961.20
|
|
|
INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$2,398.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
6147015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.65 |
| Max. Negotiated Rate |
$2,278.10 |
| Rate for Payer: Cash Price |
$1,438.80
|
| Rate for Payer: Cigna Commercial |
$2,038.30
|
| Rate for Payer: First Health Commercial |
$2,158.20
|
| Rate for Payer: First Health Workers Compensation |
$925.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,158.20
|
| Rate for Payer: GEHA Commercial |
$1,678.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,158.20
|
| Rate for Payer: Multiplan All |
$2,182.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,678.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,158.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,278.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,798.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,230.14
|
| Rate for Payer: Zelis Auto |
$959.20
|
| Rate for Payer: Zelis Worker's Compensation |
$654.65
|
|
|
INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$2,398.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
6147015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$599.50 |
| Max. Negotiated Rate |
$2,278.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,438.80
|
| Rate for Payer: Cash Price |
$1,438.80
|
| Rate for Payer: Cigna Commercial |
$2,038.30
|
| Rate for Payer: First Health Commercial |
$2,158.20
|
| Rate for Payer: First Health Workers Compensation |
$925.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,158.20
|
| Rate for Payer: GEHA Commercial |
$1,918.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,158.20
|
| Rate for Payer: Humana ChoiceCare |
$623.48
|
| Rate for Payer: Multiplan All |
$2,182.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,438.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,678.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,158.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,278.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,798.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,110.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$599.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,230.14
|
| Rate for Payer: Zelis Auto |
$959.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,199.00
|
| Rate for Payer: Zelis Worker's Compensation |
$654.65
|
|
|
INJECT EPIDURAL PATCH
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
6162273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.37 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$136.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Worker's Compensation |
$96.37
|
|
|
INJECT EPIDURAL PATCH
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
6162273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.37 |
| 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 |
$211.80
|
| 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 |
$657.58
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$136.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$282.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| 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 |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| 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 |
$335.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| 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 |
$328.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$96.37
|
|
|
INJECT FOR SPINE DISK X-RAY
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
6162290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna Commercial |
$453.90
|
| Rate for Payer: First Health Commercial |
$480.60
|
| Rate for Payer: First Health Workers Compensation |
$206.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.60
|
| Rate for Payer: GEHA Commercial |
$373.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.60
|
| Rate for Payer: Multiplan All |
$485.94
|
| Rate for Payer: OMNI Networks Commercial |
$373.80
|
| Rate for Payer: One Health Plan PPO/POS |
$480.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$507.30
|
| Rate for Payer: Three Rivers Provider Network All |
$400.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.62
|
| Rate for Payer: Zelis Auto |
$213.60
|
| Rate for Payer: Zelis Worker's Compensation |
$145.78
|
|
|
INJECT FOR SPINE DISK X-RAY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
6162291
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
INJECT FOR SPINE DISK X-RAY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
6162291
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$137.02
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.20
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$463.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$263.50
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
INJECT FOR SPINE DISK X-RAY
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
6162290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.50 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna Commercial |
$453.90
|
| Rate for Payer: First Health Commercial |
$480.60
|
| Rate for Payer: First Health Workers Compensation |
$206.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.60
|
| Rate for Payer: GEHA Commercial |
$427.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.60
|
| Rate for Payer: Humana ChoiceCare |
$138.84
|
| Rate for Payer: Multiplan All |
$485.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.40
|
| Rate for Payer: OMNI Networks Commercial |
$373.80
|
| Rate for Payer: One Health Plan PPO/POS |
$480.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$507.30
|
| Rate for Payer: Three Rivers Provider Network All |
$400.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$469.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.62
|
| Rate for Payer: Zelis Auto |
$213.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$267.00
|
| Rate for Payer: Zelis Worker's Compensation |
$145.78
|
|
|
INJECTION AA&/STRD GENICULAR NRV BRANCHE
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
6164454
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$937.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$937.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$742.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| 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 |
$757.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$875.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$757.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$757.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
INJECTION AA&/STRD GENICULAR NRV BRANCHE
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
6164454
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
INJECTION AA&/STRD GREATER OCCIPITAL NER
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
7664405
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$560.58 |
| 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 |
$153.00
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$204.00
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
INJECTION AA&/STRD GREATER OCCIPITAL NER
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
7664405
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$178.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
INJECTION AA&/STRD GREATER OCCIPITAL NER
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
20300081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$560.58 |
| 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 |
$153.00
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$204.00
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
INJECTION AA&/STRD GREATER OCCIPITAL NER
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
20300081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$178.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
INJECTION AA&/STRD GREATER OCCIPITAL NER
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
6164405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$66.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$119.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Worker's Compensation |
$46.68
|
|
|
INJECTION AA&/STRD GREATER OCCIPITAL NER
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
6164405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$560.58 |
| 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 |
$102.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$66.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$136.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$46.68
|
|
|
INJECTION AA&/STRD ILIOINGUINAL IH NERVE
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
7664425
|
|
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 |
$376.33
|
| 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 |
$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 |
$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 |
$304.20
|
| 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 |
$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 |
$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 |
$304.20
|
| 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
|
|
|
INJECTION AA&/STRD ILIOINGUINAL IH NERVE
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
20364425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.13 |
| Max. Negotiated Rate |
$1,888.60 |
| 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 |
$1,192.80
|
| 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 |
$657.58
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$1,689.80
|
| Rate for Payer: First Health Commercial |
$1,789.20
|
| Rate for Payer: First Health Workers Compensation |
$767.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,789.20
|
| Rate for Payer: GEHA Commercial |
$1,590.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,789.20
|
| 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 |
$1,809.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,391.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,789.20
|
| 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 |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,888.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.00
|
| 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 |
$1,848.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$795.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$542.72
|
|
|
INJECTION AA&/STRD ILIOINGUINAL IH NERVE
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
20364425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$542.72 |
| Max. Negotiated Rate |
$1,888.60 |
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$1,689.80
|
| Rate for Payer: First Health Commercial |
$1,789.20
|
| Rate for Payer: First Health Workers Compensation |
$767.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,789.20
|
| Rate for Payer: GEHA Commercial |
$1,391.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,789.20
|
| Rate for Payer: Multiplan All |
$1,809.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,391.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,789.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,888.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,848.84
|
| Rate for Payer: Zelis Auto |
$795.20
|
| Rate for Payer: Zelis Worker's Compensation |
$542.72
|
|
|
INJECTION AA&/STRD ILIOINGUINAL IH NERVE
|
Facility
|
IP
|
$312.87
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
8964425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$297.23 |
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cigna Commercial |
$265.94
|
| Rate for Payer: First Health Commercial |
$281.58
|
| Rate for Payer: First Health Workers Compensation |
$120.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.58
|
| Rate for Payer: GEHA Commercial |
$219.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.58
|
| Rate for Payer: Multiplan All |
$284.71
|
| Rate for Payer: OMNI Networks Commercial |
$219.01
|
| Rate for Payer: One Health Plan PPO/POS |
$281.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.23
|
| Rate for Payer: Three Rivers Provider Network All |
$234.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.97
|
| Rate for Payer: Zelis Auto |
$125.15
|
| Rate for Payer: Zelis Worker's Compensation |
$85.41
|
|
|
INJECTION AA&/STRD ILIOINGUINAL IH NERVE
|
Facility
|
OP
|
$312.87
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
8964425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.41 |
| 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 |
$187.72
|
| 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 |
$187.72
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cigna Commercial |
$265.94
|
| Rate for Payer: First Health Commercial |
$281.58
|
| Rate for Payer: First Health Workers Compensation |
$120.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.58
|
| Rate for Payer: GEHA Commercial |
$250.30
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.58
|
| 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 |
$284.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$219.01
|
| Rate for Payer: One Health Plan PPO/POS |
$281.58
|
| 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 |
$297.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$234.65
|
| 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 |
$290.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$125.15
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$85.41
|
|
