|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$287.08
|
|
|
Service Code
|
CPT 64491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$202.98 |
| Max. Negotiated Rate |
$287.08 |
| 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 Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: First Health Workers Compensation |
$287.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: Zelis Worker's Compensation |
$202.98
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL
|
Facility
|
OP
|
$1,690.74
|
|
|
Service Code
|
CPT 64490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.73 |
| 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 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: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| 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: New Mexico Health Connections Medicare |
$1,437.13
|
| 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 Worker's Compensation |
$1,690.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| 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 |
$769.29
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$267.53
|
|
|
Service Code
|
CPT 64494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.16 |
| Max. Negotiated Rate |
$267.53 |
| 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 Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: First Health Workers Compensation |
$267.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: Zelis Worker's Compensation |
$189.16
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL
|
Facility
|
OP
|
$1,690.74
|
|
|
Service Code
|
CPT 64493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.73 |
| 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 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: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| 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: New Mexico Health Connections Medicare |
$1,437.13
|
| 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 Worker's Compensation |
$1,690.74
|
| 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: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| 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 |
$769.29
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$267.53
|
|
|
Service Code
|
CPT 64495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.16 |
| Max. Negotiated Rate |
$267.53 |
| 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 Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: First Health Workers Compensation |
$267.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: Zelis Worker's Compensation |
$189.16
|
|
|
INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
6123350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$61.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$111.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Worker's Compensation |
$43.41
|
|
|
INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
6123350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$135.15
|
| Rate for Payer: First Health Commercial |
$143.10
|
| Rate for Payer: First Health Workers Compensation |
$61.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$143.10
|
| Rate for Payer: GEHA Commercial |
$127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$143.10
|
| Rate for Payer: Humana ChoiceCare |
$41.34
|
| Rate for Payer: Multiplan All |
$144.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.40
|
| Rate for Payer: OMNI Networks Commercial |
$111.30
|
| Rate for Payer: One Health Plan PPO/POS |
$143.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$151.05
|
| Rate for Payer: Three Rivers Provider Network All |
$119.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$139.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$147.87
|
| Rate for Payer: Zelis Auto |
$63.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$79.50
|
| Rate for Payer: Zelis Worker's Compensation |
$43.41
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$161.19
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8520551
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$153.13 |
| Rate for Payer: Cash Price |
$96.71
|
| Rate for Payer: Cigna Commercial |
$137.01
|
| Rate for Payer: First Health Commercial |
$145.07
|
| Rate for Payer: First Health Workers Compensation |
$62.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.07
|
| Rate for Payer: GEHA Commercial |
$112.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.07
|
| Rate for Payer: Multiplan All |
$146.68
|
| Rate for Payer: OMNI Networks Commercial |
$112.83
|
| Rate for Payer: One Health Plan PPO/POS |
$145.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.13
|
| Rate for Payer: Three Rivers Provider Network All |
$120.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$149.91
|
| Rate for Payer: Zelis Auto |
$64.48
|
| Rate for Payer: Zelis Worker's Compensation |
$44.00
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
7799216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| 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 |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| 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 |
$816.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$766.95
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
1920551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$728.60 |
| 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 |
$460.17
|
| 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 |
$460.17
|
| Rate for Payer: Cash Price |
$460.17
|
| Rate for Payer: Cigna Commercial |
$651.91
|
| Rate for Payer: First Health Commercial |
$690.25
|
| Rate for Payer: First Health Workers Compensation |
$296.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$690.25
|
| Rate for Payer: GEHA Commercial |
$613.56
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$690.25
|
| 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 |
$697.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$536.87
|
| Rate for Payer: One Health Plan PPO/POS |
$690.25
|
| 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 |
$728.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$575.21
|
| 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 |
$713.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$306.78
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$209.38
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9400038
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.77 |
| 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 |
$98.40
|
| 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 |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| 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 |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| 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 |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| 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 |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
21600148
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.58 |
| 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 |
$80.40
|
| 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 |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| 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 |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| 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 |
$127.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| 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 |
$124.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$766.95
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
1920551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$728.60 |
| Rate for Payer: Cash Price |
$460.17
|
| Rate for Payer: Cigna Commercial |
$651.91
|
| Rate for Payer: First Health Commercial |
$690.25
|
| Rate for Payer: First Health Workers Compensation |
$296.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$690.25
|
| Rate for Payer: GEHA Commercial |
$536.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$690.25
|
| Rate for Payer: Multiplan All |
$697.92
|
| Rate for Payer: OMNI Networks Commercial |
$536.87
|
| Rate for Payer: One Health Plan PPO/POS |
$690.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$728.60
|
| Rate for Payer: Three Rivers Provider Network All |
$575.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$713.26
|
| Rate for Payer: Zelis Auto |
$306.78
|
| Rate for Payer: Zelis Worker's Compensation |
$209.38
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
7799216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.69 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: First Health Workers Compensation |
$339.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Worker's Compensation |
$239.69
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
6120551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
21600148
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$797.00
|
|
| Hospital Charge Code |
8120551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.58 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$161.19
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8520551
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.00 |
| 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 |
$96.71
|
| 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 |
$96.71
|
| Rate for Payer: Cash Price |
$96.71
|
| Rate for Payer: Cigna Commercial |
$137.01
|
| Rate for Payer: First Health Commercial |
$145.07
|
| Rate for Payer: First Health Workers Compensation |
$62.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.07
|
| Rate for Payer: GEHA Commercial |
$128.95
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.07
|
| 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 |
$146.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$112.83
|
| Rate for Payer: One Health Plan PPO/POS |
$145.07
|
| 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 |
$153.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$120.89
|
| 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 |
$149.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$64.48
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.00
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$161.19
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
7220551
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$153.13 |
| Rate for Payer: Cash Price |
$96.71
|
| Rate for Payer: Cigna Commercial |
$137.01
|
| Rate for Payer: First Health Commercial |
$145.07
|
| Rate for Payer: First Health Workers Compensation |
$62.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.07
|
| Rate for Payer: GEHA Commercial |
$112.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.07
|
| Rate for Payer: Multiplan All |
$146.68
|
| Rate for Payer: OMNI Networks Commercial |
$112.83
|
| Rate for Payer: One Health Plan PPO/POS |
$145.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.13
|
| Rate for Payer: Three Rivers Provider Network All |
$120.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$149.91
|
| Rate for Payer: Zelis Auto |
$64.48
|
| Rate for Payer: Zelis Worker's Compensation |
$44.00
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
6120551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$36.58 |
| 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 |
$80.40
|
| 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 |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| 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 |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| 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 |
$127.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| 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 |
$124.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8204021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.77 |
| 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 |
$98.40
|
| 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 |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| 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 |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| 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 |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| 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 |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$161.19
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
7220551
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.00 |
| 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 |
$96.71
|
| 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 |
$96.71
|
| Rate for Payer: Cash Price |
$96.71
|
| Rate for Payer: Cigna Commercial |
$137.01
|
| Rate for Payer: First Health Commercial |
$145.07
|
| Rate for Payer: First Health Workers Compensation |
$62.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.07
|
| Rate for Payer: GEHA Commercial |
$128.95
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.07
|
| 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 |
$146.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$112.83
|
| Rate for Payer: One Health Plan PPO/POS |
$145.07
|
| 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 |
$153.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$120.89
|
| 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 |
$149.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$64.48
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.00
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8204021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
8800042
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.77 |
| 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 |
$98.40
|
| 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 |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| 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 |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| 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 |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| 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 |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$797.00
|
|
| Hospital Charge Code |
8120551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$207.22
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$478.20
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$701.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$398.50
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
