|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
21999408
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$468.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Humana ChoiceCare |
$152.10
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$351.00
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$514.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.50
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
9899223
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$159.71 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$409.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
5099223
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$159.71 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$409.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
21799477
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$159.71 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$409.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
21999408
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$159.71 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$409.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
21799477
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$468.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Humana ChoiceCare |
$152.10
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$351.00
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$514.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.50
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INITL HOSP INPT/OBS CARE PER DAY/75 MIN
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
5099223
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$497.25
|
| Rate for Payer: First Health Commercial |
$526.50
|
| Rate for Payer: First Health Workers Compensation |
$225.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$526.50
|
| Rate for Payer: GEHA Commercial |
$468.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$526.50
|
| Rate for Payer: Humana ChoiceCare |
$152.10
|
| Rate for Payer: Multiplan All |
$532.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$351.00
|
| Rate for Payer: OMNI Networks Commercial |
$409.50
|
| Rate for Payer: One Health Plan PPO/POS |
$526.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$555.75
|
| Rate for Payer: Three Rivers Provider Network All |
$438.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$514.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.05
|
| Rate for Payer: Zelis Auto |
$234.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.50
|
| Rate for Payer: Zelis Worker's Compensation |
$159.71
|
|
|
INIT PHYS E&M DIABETIC PT W/LOPS
|
Facility
|
IP
|
$178.05
|
|
|
Service Code
|
CPT G0245
|
| Hospital Charge Code |
8500245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.61 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Cash Price |
$106.83
|
| Rate for Payer: Cigna Commercial |
$151.34
|
| Rate for Payer: First Health Commercial |
$160.25
|
| Rate for Payer: First Health Workers Compensation |
$68.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.25
|
| Rate for Payer: GEHA Commercial |
$124.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.25
|
| Rate for Payer: Multiplan All |
$162.03
|
| Rate for Payer: OMNI Networks Commercial |
$124.64
|
| Rate for Payer: One Health Plan PPO/POS |
$160.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.15
|
| Rate for Payer: Three Rivers Provider Network All |
$133.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.59
|
| Rate for Payer: Zelis Auto |
$71.22
|
| Rate for Payer: Zelis Worker's Compensation |
$48.61
|
|
|
INIT PHYS E&M DIABETIC PT W/LOPS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT G0245
|
| Hospital Charge Code |
8700245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$70.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$81.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$70.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
INIT PHYS E&M DIABETIC PT W/LOPS
|
Facility
|
OP
|
$178.05
|
|
|
Service Code
|
CPT G0245
|
| Hospital Charge Code |
8500245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.61 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$106.83
|
| Rate for Payer: Cash Price |
$106.83
|
| Rate for Payer: Cigna Commercial |
$151.34
|
| Rate for Payer: First Health Commercial |
$160.25
|
| Rate for Payer: First Health Workers Compensation |
$68.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.25
|
| Rate for Payer: GEHA Commercial |
$142.44
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.25
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$70.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$162.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$124.64
|
| Rate for Payer: One Health Plan PPO/POS |
$160.25
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$81.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$70.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$133.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$71.22
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$48.61
|
|
|
INIT PHYS E&M DIABETIC PT W/LOPS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT G0245
|
| Hospital Charge Code |
8700245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
INIT PHYS E&M DIABETIC PT W/LOPS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT G0245
|
| Hospital Charge Code |
9600245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$70.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$81.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$70.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
INIT PHYS E&M DIABETIC PT W/LOPS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT G0245
|
| Hospital Charge Code |
9600245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$1,080.00
|
|
| Hospital Charge Code |
8120550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.84 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$918.00
|
| Rate for Payer: First Health Commercial |
$972.00
|
| Rate for Payer: First Health Workers Compensation |
$416.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$972.00
|
| Rate for Payer: GEHA Commercial |
$756.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.00
|
| Rate for Payer: Multiplan All |
$982.80
|
| Rate for Payer: OMNI Networks Commercial |
$756.00
|
| Rate for Payer: One Health Plan PPO/POS |
$972.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,026.00
|
| Rate for Payer: Three Rivers Provider Network All |
$810.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,004.40
|
| Rate for Payer: Zelis Auto |
$432.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.84
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8800041
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.23 |
| 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 |
$97.20
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| 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 |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| 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 |
$150.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
7620550
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$1,122.37
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9620550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,066.25 |
| 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 |
$673.42
|
| 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 |
$673.42
|
| Rate for Payer: Cash Price |
$673.42
|
| Rate for Payer: Cigna Commercial |
$954.01
|
| Rate for Payer: First Health Commercial |
$1,010.13
|
| Rate for Payer: First Health Workers Compensation |
$433.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.13
|
| Rate for Payer: GEHA Commercial |
$897.90
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.13
|
| 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 |
$1,021.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$785.66
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.13
|
| 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 |
$1,066.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$841.78
|
| 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 |
$1,043.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$448.95
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$306.41
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8230000
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
1002012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.84 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$918.00
|
| Rate for Payer: First Health Commercial |
$972.00
|
| Rate for Payer: First Health Workers Compensation |
$416.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$972.00
|
| Rate for Payer: GEHA Commercial |
$756.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.00
|
| Rate for Payer: Multiplan All |
$982.80
|
| Rate for Payer: OMNI Networks Commercial |
$756.00
|
| Rate for Payer: One Health Plan PPO/POS |
$972.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,026.00
|
| Rate for Payer: Three Rivers Provider Network All |
$810.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,004.40
|
| Rate for Payer: Zelis Auto |
$432.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.84
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$163.44
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8599500
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.62 |
| 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 |
$98.06
|
| 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 |
$98.06
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: First Health Commercial |
$147.10
|
| Rate for Payer: First Health Workers Compensation |
$63.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.10
|
| Rate for Payer: GEHA Commercial |
$130.75
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.10
|
| 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 |
$148.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$114.41
|
| Rate for Payer: One Health Plan PPO/POS |
$147.10
|
| 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 |
$155.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$122.58
|
| 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 |
$152.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$65.38
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.62
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
6120550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20300059
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.23 |
| 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 |
$97.20
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| 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 |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| 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 |
$150.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$1,122.37
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9620550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$306.41 |
| Max. Negotiated Rate |
$1,066.25 |
| Rate for Payer: Cash Price |
$673.42
|
| Rate for Payer: Cigna Commercial |
$954.01
|
| Rate for Payer: First Health Commercial |
$1,010.13
|
| Rate for Payer: First Health Workers Compensation |
$433.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.13
|
| Rate for Payer: GEHA Commercial |
$785.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.13
|
| Rate for Payer: Multiplan All |
$1,021.36
|
| Rate for Payer: OMNI Networks Commercial |
$785.66
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.25
|
| Rate for Payer: Three Rivers Provider Network All |
$841.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.80
|
| Rate for Payer: Zelis Auto |
$448.95
|
| Rate for Payer: Zelis Worker's Compensation |
$306.41
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8230000
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.23 |
| 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 |
$97.20
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| 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 |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| 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 |
$150.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8720550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
