|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
7799216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.69 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: First Health Workers Compensation |
$339.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Worker's Compensation |
$239.69
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$168.84
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9620551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.09 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$101.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$101.30
|
| Rate for Payer: Cash Price |
$101.30
|
| Rate for Payer: Cigna Commercial |
$143.51
|
| Rate for Payer: First Health Commercial |
$151.96
|
| Rate for Payer: First Health Workers Compensation |
$65.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.96
|
| Rate for Payer: GEHA Commercial |
$135.07
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.96
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$153.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$118.19
|
| Rate for Payer: One Health Plan PPO/POS |
$151.96
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$160.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$126.63
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$157.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$67.54
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$46.09
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
7799216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8204021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
|
Facility
|
OP
|
$1,342.08
|
|
|
Service Code
|
CPT 62321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$1,342.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$671.04
|
| Rate for Payer: First Health Workers Compensation |
$863.63
|
| Rate for Payer: GEHA Medicare |
$671.04
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Humana Medicare Advantage |
$671.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$671.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$671.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,342.08
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$671.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$671.04
|
| Rate for Payer: Zelis Medicare |
$570.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$805.25
|
| Rate for Payer: Zelis Worker's Compensation |
$610.65
|
|
|
INJECTION TEMPOROMANDIBULAR JOINT ARTHRO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
6121116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
INJECTION TEMPOROMANDIBULAR JOINT ARTHRO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
6121116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
INJECTION TESTO ENANTHATE 1 MG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT J3121
|
| Hospital Charge Code |
8503121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$0.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJECTION TESTO ENANTHATE 1 MG
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT J3121
|
| Hospital Charge Code |
8503121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
8800039
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
6120526
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
8204016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
8204016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
8800039
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
6120526
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
INJECTION THERAPY OF VEIN
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
6136470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| 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 |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$387.14
|
| 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 |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| 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 |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
INJECTION THERAPY OF VEIN
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
6136470
|
|
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 THERAPY OF VEINS
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
6136471
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$774.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$387.14
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: GEHA Medicare |
$387.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$425.85
|
| Rate for Payer: Humana Medicare Advantage |
$387.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$650.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$387.14
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$658.14
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$387.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$774.28
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$387.14
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Medicare |
$329.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.57
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
INJECTION THERAPY OF VEINS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
6136471
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: First Health Workers Compensation |
$121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Worker's Compensation |
$86.00
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
CPT 64681
|
| Hospital Charge Code |
6164681
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$560.50 |
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$501.50
|
| Rate for Payer: First Health Commercial |
$531.00
|
| Rate for Payer: First Health Workers Compensation |
$227.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.00
|
| Rate for Payer: GEHA Commercial |
$413.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.00
|
| Rate for Payer: Multiplan All |
$536.90
|
| Rate for Payer: OMNI Networks Commercial |
$413.00
|
| Rate for Payer: One Health Plan PPO/POS |
$531.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$560.50
|
| Rate for Payer: Three Rivers Provider Network All |
$442.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$548.70
|
| Rate for Payer: Zelis Auto |
$236.00
|
| Rate for Payer: Zelis Worker's Compensation |
$161.07
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
6164680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: First Health Workers Compensation |
$196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$357.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$139.23
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
6164620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$1,725.34 |
| 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 |
$316.20
|
| 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 |
$862.67
|
| Rate for Payer: Cash Price |
$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: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| 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 |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
6164600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$396.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
6164610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$3,784.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$621.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,892.20
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$828.80
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$414.40
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$282.83
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
6164680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$1,725.34 |
| 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 |
$306.00
|
| 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 |
$862.67
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: First Health Workers Compensation |
$196.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$408.00
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| 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 |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$139.23
|
|
