|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
6164490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.54 |
| 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 |
$196.80
|
| 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 |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$278.80
|
| Rate for Payer: First Health Commercial |
$295.20
|
| Rate for Payer: First Health Workers Compensation |
$126.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$295.20
|
| Rate for Payer: GEHA Commercial |
$262.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$295.20
|
| 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 |
$298.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$229.60
|
| Rate for Payer: One Health Plan PPO/POS |
$295.20
|
| 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 |
$311.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$246.00
|
| 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 |
$305.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$131.20
|
| 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 |
$89.54
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 1 LVL
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
7664490
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$154.52 |
| 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 |
$339.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$218.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$452.80
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| 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 |
$515.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| 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 |
$526.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$154.52
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
6164491
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
21764491
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
7664491
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
6164491
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
21900153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
7664491
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
21764491
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 2 LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
21900153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
6164492
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
21900154
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
21764492
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
21764492
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
6164492
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
7664492
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
7664492
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$73.84 |
| Max. Negotiated Rate |
$269.80 |
| 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 |
$170.40
|
| 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: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT C/T 3+ LVL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
21900154
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$77.53
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
21700002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$359.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
21900111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.32 |
| 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 |
$308.40
|
| 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 |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$411.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| 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 |
$488.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| 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 |
$478.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$205.60
|
| 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 |
$140.32
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
21700002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.32 |
| 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 |
$308.40
|
| 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 |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$411.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| 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 |
$488.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| 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 |
$478.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$205.60
|
| 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 |
$140.32
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
7664493
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$359.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
7664493
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$140.32 |
| 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 |
$308.40
|
| 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 |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$411.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| 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 |
$488.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| 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 |
$478.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$205.60
|
| 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 |
$140.32
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
21900111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$359.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
NJX DX/THER AGT PVRT FACET JT L/S 1 LVL
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
6164493
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
