|
NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
6143752
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$122.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$122.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$97.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$99.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$114.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$99.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$99.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
NA URINE POP
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2299385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
NA URINE POP
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2299385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$5.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$5.57
|
| Rate for Payer: Humana Medicare Advantage |
$5.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.06
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.60
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.12
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.96
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.06
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$4.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.07
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
NAVIGATIONAL BRONCHOSCOPY
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
6131627
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$261.80
|
| Rate for Payer: First Health Commercial |
$277.20
|
| Rate for Payer: First Health Workers Compensation |
$118.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$277.20
|
| Rate for Payer: GEHA Commercial |
$246.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$277.20
|
| Rate for Payer: Humana ChoiceCare |
$80.08
|
| Rate for Payer: Multiplan All |
$280.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$184.80
|
| Rate for Payer: OMNI Networks Commercial |
$215.60
|
| Rate for Payer: One Health Plan PPO/POS |
$277.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$292.60
|
| Rate for Payer: Three Rivers Provider Network All |
$231.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$271.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$77.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$286.44
|
| Rate for Payer: Zelis Auto |
$123.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.08
|
|
|
NAVIGATIONAL BRONCHOSCOPY
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
6131627
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$261.80
|
| Rate for Payer: First Health Commercial |
$277.20
|
| Rate for Payer: First Health Workers Compensation |
$118.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$277.20
|
| Rate for Payer: GEHA Commercial |
$215.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$277.20
|
| Rate for Payer: Multiplan All |
$280.28
|
| Rate for Payer: OMNI Networks Commercial |
$215.60
|
| Rate for Payer: One Health Plan PPO/POS |
$277.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$292.60
|
| Rate for Payer: Three Rivers Provider Network All |
$231.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$286.44
|
| Rate for Payer: Zelis Auto |
$123.20
|
| Rate for Payer: Zelis Worker's Compensation |
$84.08
|
|
|
N BLOCK INJ CELIAC PELUS
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
6164530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.26 |
| 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 |
$169.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: First Health Workers Compensation |
$109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$226.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| 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 |
$257.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| 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 |
$268.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| 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 |
$263.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$113.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$77.26
|
|
|
N BLOCK INJ CELIAC PELUS
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
6164530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: First Health Workers Compensation |
$109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$198.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| Rate for Payer: Multiplan All |
$257.53
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.85
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$263.19
|
| Rate for Payer: Zelis Auto |
$113.20
|
| Rate for Payer: Zelis Worker's Compensation |
$77.26
|
|
|
N BLOCK INJ COMMON DIGIT
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
6164632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$560.58 |
| 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 |
$126.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$179.35
|
| Rate for Payer: First Health Commercial |
$189.90
|
| Rate for Payer: First Health Workers Compensation |
$81.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.90
|
| Rate for Payer: GEHA Commercial |
$168.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.90
|
| 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 |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$192.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$147.70
|
| Rate for Payer: One Health Plan PPO/POS |
$189.90
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$200.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$158.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$196.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$84.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$57.60
|
|
|
N BLOCK INJ COMMON DIGIT
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
6164632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$179.35
|
| Rate for Payer: First Health Commercial |
$189.90
|
| Rate for Payer: First Health Workers Compensation |
$81.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.90
|
| Rate for Payer: GEHA Commercial |
$147.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.90
|
| Rate for Payer: Multiplan All |
$192.01
|
| Rate for Payer: OMNI Networks Commercial |
$147.70
|
| Rate for Payer: One Health Plan PPO/POS |
$189.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$200.45
|
| Rate for Payer: Three Rivers Provider Network All |
$158.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$196.23
|
| Rate for Payer: Zelis Auto |
$84.40
|
| Rate for Payer: Zelis Worker's Compensation |
$57.60
|
|
|
N BLOCK INJ HYPOGAS PLXS
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
6164517
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: First Health Commercial |
$340.20
|
| Rate for Payer: First Health Workers Compensation |
$145.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$340.20
|
| Rate for Payer: GEHA Commercial |
$264.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$340.20
|
| Rate for Payer: Multiplan All |
$343.98
|
| Rate for Payer: OMNI Networks Commercial |
$264.60
|
| Rate for Payer: One Health Plan PPO/POS |
$340.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$359.10
|
| Rate for Payer: Three Rivers Provider Network All |
$283.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$351.54
|
| Rate for Payer: Zelis Auto |
$151.20
|
| Rate for Payer: Zelis Worker's Compensation |
$103.19
|
|
|
N BLOCK INJ HYPOGAS PLXS
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
6164517
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$103.19 |
| 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 |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: First Health Commercial |
$340.20
|
| Rate for Payer: First Health Workers Compensation |
$145.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$340.20
|
| Rate for Payer: GEHA Commercial |
$302.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$340.20
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$343.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$264.60
|
| Rate for Payer: One Health Plan PPO/POS |
$340.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$283.50
|
| 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 |
$351.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$151.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$103.19
|
|
|
N BLOCK INJ INTERCOST SNG
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
6164420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.33 |
| 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 |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$81.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| 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 |
$195.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$57.33
|
|
|
N BLOCK INJ INTERCOST SNG
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
6164420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$81.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$147.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Worker's Compensation |
$57.33
|
|
|
N BLOCK INJ LUMBAR PLEXUS
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 64449
|
| Hospital Charge Code |
6164449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Worker's Compensation |
$71.80
|
|
|
N BLOCK INJ LUMBAR PLEXUS
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 64449
|
| Hospital Charge Code |
6164449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.80 |
| 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 |
$157.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: First Health Workers Compensation |
$101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| 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 |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| 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 |
$249.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| 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 |
$244.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$71.80
|
|
|
N BLOCK INJ PARACERVICAL
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
6164435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.16 |
| 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 |
$154.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$99.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$205.60
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| 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 |
$233.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| 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 |
$244.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| 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 |
$239.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$70.16
|
|
|
N BLOCK INJ PARACERVICAL
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
6164435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$99.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$179.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.16
|
|
|
N BLOCK INJ SUPRASCAPULAR
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
6164418
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$64.16 |
| 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 |
$141.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: First Health Workers Compensation |
$90.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$188.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| 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 |
$213.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| 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 |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| 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 |
$218.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$94.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$64.16
|
|
|
N BLOCK INJ SUPRASCAPULAR
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
6164418
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$64.16 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: First Health Workers Compensation |
$90.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$164.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
| Rate for Payer: Zelis Worker's Compensation |
$64.16
|
|
|
N BLOCK INJ TRIGEMINAL
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
6164400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$334.90
|
| Rate for Payer: First Health Commercial |
$354.60
|
| Rate for Payer: First Health Workers Compensation |
$152.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$354.60
|
| Rate for Payer: GEHA Commercial |
$275.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$354.60
|
| Rate for Payer: Multiplan All |
$358.54
|
| Rate for Payer: OMNI Networks Commercial |
$275.80
|
| Rate for Payer: One Health Plan PPO/POS |
$354.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$374.30
|
| Rate for Payer: Three Rivers Provider Network All |
$295.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$366.42
|
| Rate for Payer: Zelis Auto |
$157.60
|
| Rate for Payer: Zelis Worker's Compensation |
$107.56
|
|
|
N BLOCK INJ TRIGEMINAL
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
6164400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$560.58 |
| 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 |
$236.40
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$334.90
|
| Rate for Payer: First Health Commercial |
$354.60
|
| Rate for Payer: First Health Workers Compensation |
$152.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$354.60
|
| Rate for Payer: GEHA Commercial |
$315.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$354.60
|
| 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 |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$358.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$275.80
|
| Rate for Payer: One Health Plan PPO/POS |
$354.60
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$374.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$295.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$366.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$157.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$107.56
|
|
|
N BLOCK INJ VAGUS
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
6164408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$728.01 |
| 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 |
$138.00
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$184.00
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| 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 |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
N BLOCK INJ VAGUS
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
6164408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$195.50
|
| Rate for Payer: First Health Commercial |
$207.00
|
| Rate for Payer: First Health Workers Compensation |
$88.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.00
|
| Rate for Payer: GEHA Commercial |
$161.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.00
|
| Rate for Payer: Multiplan All |
$209.30
|
| Rate for Payer: OMNI Networks Commercial |
$161.00
|
| Rate for Payer: One Health Plan PPO/POS |
$207.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$218.50
|
| Rate for Payer: Three Rivers Provider Network All |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$213.90
|
| Rate for Payer: Zelis Auto |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.79
|
|
|
N BLOCK LUMBAR/THORACIC
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
6164520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| 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 |
$149.40
|
| 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 |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| 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 |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| 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 |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| 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 |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
N BLOCK LUMBAR/THORACIC
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
6164520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
