|
INJECTION INTO HEMORRHOID(S)
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
6146500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$299.20
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
|
INJECTION INTO SKIN LESIONS
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
6111900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$37.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$67.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Worker's Compensation |
$26.48
|
|
|
INJECTION INTO SKIN LESIONS
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
6111900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$37.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$77.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.48
|
|
|
INJECTION INTO SPINAL ARTERY
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
6162294
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.71 |
| 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 |
$964.20
|
| 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 |
$964.20
|
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cigna Commercial |
$1,365.95
|
| Rate for Payer: First Health Commercial |
$1,446.30
|
| Rate for Payer: First Health Workers Compensation |
$620.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,446.30
|
| Rate for Payer: GEHA Commercial |
$1,285.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,446.30
|
| 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 |
$1,462.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,446.30
|
| 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 |
$1,526.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,205.25
|
| 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 |
$1,494.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$642.80
|
| 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 |
$438.71
|
|
|
INJECTION INTO SPINAL ARTERY
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
6162294
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.71 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cigna Commercial |
$1,365.95
|
| Rate for Payer: First Health Commercial |
$1,446.30
|
| Rate for Payer: First Health Workers Compensation |
$620.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,446.30
|
| Rate for Payer: GEHA Commercial |
$1,124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,446.30
|
| Rate for Payer: Multiplan All |
$1,462.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,446.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,526.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,205.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,494.51
|
| Rate for Payer: Zelis Auto |
$642.80
|
| Rate for Payer: Zelis Worker's Compensation |
$438.71
|
|
|
INJECTION INTO VOCAL CORD
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 31513
|
| Hospital Charge Code |
6131513
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$158.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$287.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.93
|
|
|
INJECTION INTO VOCAL CORD
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 31513
|
| Hospital Charge Code |
6131513
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$737.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$368.72
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$158.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$328.00
|
| Rate for Payer: GEHA Medicare |
$368.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Humana ChoiceCare |
$405.59
|
| Rate for Payer: Humana Medicare Advantage |
$368.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$619.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$368.72
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$626.82
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$368.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$737.44
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$368.72
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Medicare |
$313.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.46
|
| Rate for Payer: Zelis Worker's Compensation |
$111.93
|
|
|
INJECTION INTRALESIONAL >7 LESIONS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 11901
|
| Hospital Charge Code |
6111901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
INJECTION INTRALESIONAL >7 LESIONS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 11901
|
| Hospital Charge Code |
20311901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
INJECTION INTRALESIONAL >7 LESIONS
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 11901
|
| Hospital Charge Code |
6111901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
INJECTION INTRALESIONAL >7 LESIONS
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 11901
|
| Hospital Charge Code |
20311901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
INJECTION INTRALESIONAL UP TO & INCLUD 7
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
1911900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.72 |
| Max. Negotiated Rate |
$392.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$247.73
|
| Rate for Payer: Cash Price |
$247.73
|
| Rate for Payer: Cigna Commercial |
$350.95
|
| Rate for Payer: First Health Commercial |
$371.59
|
| Rate for Payer: First Health Workers Compensation |
$159.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.59
|
| Rate for Payer: GEHA Commercial |
$330.30
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.59
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$375.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$289.02
|
| Rate for Payer: One Health Plan PPO/POS |
$371.59
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$309.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$165.15
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$112.72
|
|
|
INJECTION INTRALESIONAL UP TO & INCLUD 7
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
1911900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.72 |
| Max. Negotiated Rate |
$392.24 |
| Rate for Payer: Cash Price |
$247.73
|
| Rate for Payer: Cigna Commercial |
$350.95
|
| Rate for Payer: First Health Commercial |
$371.59
|
| Rate for Payer: First Health Workers Compensation |
$159.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.59
|
| Rate for Payer: GEHA Commercial |
$289.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.59
|
| Rate for Payer: Multiplan All |
$375.72
|
| Rate for Payer: OMNI Networks Commercial |
$289.02
|
| Rate for Payer: One Health Plan PPO/POS |
$371.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.24
|
| Rate for Payer: Three Rivers Provider Network All |
$309.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.98
|
| Rate for Payer: Zelis Auto |
$165.15
|
| Rate for Payer: Zelis Worker's Compensation |
$112.72
|
|
|
INJECTION INTRAOP ADD-ON
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 48400
|
| Hospital Charge Code |
6148400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.36 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$231.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Worker's Compensation |
$90.36
|
|
|
INJECTION INTRAOP ADD-ON
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 48400
|
| Hospital Charge Code |
6148400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$264.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Humana ChoiceCare |
$86.06
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$198.60
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$291.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$165.50
|
| Rate for Payer: Zelis Worker's Compensation |
$90.36
|
|
|
INJECTION OF SINUS TRACT
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
6120500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: First Health Workers Compensation |
$99.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$180.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
INJECTION OF SINUS TRACT
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
6120500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: First Health Workers Compensation |
$99.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$206.40
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
INJECTION ONDANSETRON HCL PER 1 MG
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
8502405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
INJECTION ONDANSETRON HCL PER 1 MG
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
8502405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$0.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY
|
Facility
|
OP
|
$1,315.16
|
|
|
Service Code
|
CPT G0260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$558.94 |
| 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 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: First Health Workers Compensation |
$846.31
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| 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 |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| 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 Worker's Compensation |
$1,315.16
|
| 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: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$1,315.16
|
|
|
Service Code
|
CPT 64447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.13 |
| 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 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: First Health Workers Compensation |
$846.31
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| 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: New Mexico Health Connections Medicare |
$1,117.89
|
| 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 Worker's Compensation |
$1,315.16
|
| 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: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY)
|
Facility
|
OP
|
$1,315.16
|
|
|
Service Code
|
CPT 64451
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$558.94 |
| 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 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: First Health Workers Compensation |
$846.31
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| 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 |
$757.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| 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 Worker's Compensation |
$1,315.16
|
| 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: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, SINGLE LEVEL
|
Facility
|
OP
|
$1,690.74
|
|
|
Service Code
|
CPT 64479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.73 |
| 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 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: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| 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: New Mexico Health Connections Medicare |
$1,437.13
|
| 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 Worker's Compensation |
$1,690.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| 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
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$376.33
|
|
|
Service Code
|
CPT 64484
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$229.17 |
| Max. Negotiated Rate |
$376.33 |
| 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 Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: First Health Workers Compensation |
$324.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: Zelis Worker's Compensation |
$229.17
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL
|
Facility
|
OP
|
$1,690.74
|
|
|
Service Code
|
CPT 64483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.73 |
| 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 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: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| 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: New Mexico Health Connections Medicare |
$1,437.13
|
| 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 Worker's Compensation |
$1,690.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| 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
|
|
