|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$1,122.37
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
1920550
|
|
Hospital Revenue Code
|
761
|
| 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
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9400037
|
|
Hospital Revenue Code
|
517
|
| 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
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20300059
|
|
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
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
21600143
|
|
Hospital Revenue Code
|
517
|
| 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
|
$1,080.00
|
|
| Hospital Charge Code |
8120550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$648.00
|
| 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 |
$864.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.00
|
| Rate for Payer: Humana ChoiceCare |
$280.80
|
| Rate for Payer: Multiplan All |
$982.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$950.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,004.40
|
| Rate for Payer: Zelis Auto |
$432.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$540.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.84
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
6120550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.85 |
| 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 |
$74.40
|
| 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 |
$74.40
|
| 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 |
$99.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| 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 |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| 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 |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| 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 |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8800041
|
|
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
|
$163.44
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
7220550
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$155.27 |
| 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 |
$114.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.10
|
| Rate for Payer: Multiplan All |
$148.73
|
| Rate for Payer: OMNI Networks Commercial |
$114.41
|
| Rate for Payer: One Health Plan PPO/POS |
$147.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.27
|
| Rate for Payer: Three Rivers Provider Network All |
$122.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.00
|
| Rate for Payer: Zelis Auto |
$65.38
|
| Rate for Payer: Zelis Worker's Compensation |
$44.62
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$163.44
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
7220550
|
|
Hospital Revenue Code
|
517
|
| 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
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9400037
|
|
Hospital Revenue Code
|
517
|
| 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
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
7620550
|
|
Hospital Revenue Code
|
983
|
| 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
|
$163.44
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8599500
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$155.27 |
| 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 |
$114.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.10
|
| Rate for Payer: Multiplan All |
$148.73
|
| Rate for Payer: OMNI Networks Commercial |
$114.41
|
| Rate for Payer: One Health Plan PPO/POS |
$147.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.27
|
| Rate for Payer: Three Rivers Provider Network All |
$122.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.00
|
| Rate for Payer: Zelis Auto |
$65.38
|
| Rate for Payer: Zelis Worker's Compensation |
$44.62
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$1,122.37
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
1920550
|
|
Hospital Revenue Code
|
761
|
| 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
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
21600143
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$33.85 |
| 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 |
$74.40
|
| 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 |
$74.40
|
| 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 |
$99.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| 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 |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| 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 |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| 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 |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
8720550
|
|
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 AA&/STRD BRACH PLS CONT NFX CATH IMG
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
6164416
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.43 |
| 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 |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$95.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$197.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| 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 |
$229.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$67.43
|
|
|
INJ AA&/STRD BRACH PLS CONT NFX CATH IMG
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
6164416
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$95.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$172.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Worker's Compensation |
$67.43
|
|
|
INJ AA&/STRD FEMRL NRV CONT NFS CATH IMG
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
6164448
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.61 |
| 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 |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| 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 |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| 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 |
$210.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| 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 |
$206.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
INJ AA&/STRD FEMRL NRV CONT NFS CATH IMG
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
6164448
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
INJ AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 64451
|
| Hospital Charge Code |
6164451
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$937.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$937.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$742.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: 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 |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$757.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| 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 |
$875.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$757.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$757.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
INJ AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 64451
|
| Hospital Charge Code |
6164451
|
|
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
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
7664450
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6164450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.67 |
| 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 |
$82.80
|
| 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 |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| 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 |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| 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 |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| 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 |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
21600147
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$37.67 |
| 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 |
$82.80
|
| 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 |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| 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 |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| 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 |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| 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 |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
INJ AA&/STRD OTHER PERIPHERAL NERV/BRANC
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
1900039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.13 |
| Max. Negotiated Rate |
$2,759.75 |
| 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 |
$1,743.00
|
| 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 |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,614.50
|
| Rate for Payer: First Health Workers Compensation |
$1,121.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,614.50
|
| Rate for Payer: GEHA Commercial |
$2,324.00
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,614.50
|
| 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 |
$2,643.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,033.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,614.50
|
| 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 |
$2,759.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,178.75
|
| 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 |
$2,701.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$1,162.00
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$793.07
|
|
