|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 64605
|
| Hospital Charge Code |
6164605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.51 |
| Max. Negotiated Rate |
$3,784.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,892.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$739.50
|
| Rate for Payer: First Health Commercial |
$783.00
|
| Rate for Payer: First Health Workers Compensation |
$335.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.00
|
| Rate for Payer: GEHA Commercial |
$696.00
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.00
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$791.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$609.00
|
| Rate for Payer: One Health Plan PPO/POS |
$783.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$826.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$652.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$809.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$348.00
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$237.51
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
6164630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.71 |
| Max. Negotiated Rate |
$1,725.34 |
| 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 |
$357.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$862.67
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$230.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$476.80
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$162.71
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
6164610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$984.20 |
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$725.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: Zelis Auto |
$414.40
|
| Rate for Payer: Zelis Worker's Compensation |
$282.83
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
CPT 64681
|
| Hospital Charge Code |
6164681
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$1,725.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,339.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,339.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,060.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$862.67
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$501.50
|
| Rate for Payer: First Health Commercial |
$531.00
|
| Rate for Payer: First Health Workers Compensation |
$227.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.00
|
| Rate for Payer: GEHA Commercial |
$472.00
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.00
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,082.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$536.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$413.00
|
| Rate for Payer: One Health Plan PPO/POS |
$531.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,249.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,082.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$560.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$442.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,082.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$548.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$236.00
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$161.07
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
6164600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$1,725.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,339.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,339.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,060.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$862.67
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,082.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,249.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,082.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,082.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 64605
|
| Hospital Charge Code |
6164605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.51 |
| Max. Negotiated Rate |
$826.50 |
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$739.50
|
| Rate for Payer: First Health Commercial |
$783.00
|
| Rate for Payer: First Health Workers Compensation |
$335.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.00
|
| Rate for Payer: GEHA Commercial |
$609.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.00
|
| Rate for Payer: Multiplan All |
$791.70
|
| Rate for Payer: OMNI Networks Commercial |
$609.00
|
| Rate for Payer: One Health Plan PPO/POS |
$783.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$826.50
|
| Rate for Payer: Three Rivers Provider Network All |
$652.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$809.10
|
| Rate for Payer: Zelis Auto |
$348.00
|
| Rate for Payer: Zelis Worker's Compensation |
$237.51
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
6164630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.71 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$230.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$417.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Worker's Compensation |
$162.71
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
6164620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
INJECTION TREATMENT OF NOSE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
6130200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
INJECTION TREATMENT OF NOSE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
6130200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$986.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$493.45
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$493.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$542.79
|
| Rate for Payer: Humana Medicare Advantage |
$493.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$829.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$493.45
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.87
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$493.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$986.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$483.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$493.45
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$419.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$592.14
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
INJECTION WRIST ARTHROGRAPHY
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
6125246
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
INJECTION WRIST ARTHROGRAPHY
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
6125246
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$187.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Humana ChoiceCare |
$60.84
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$140.40
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$205.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.00
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
INJECT JOINT LARGE
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
2407184
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$612.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,110.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Worker's Compensation |
$432.98
|
|
|
INJECT JOINT LARGE
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
2407184
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,506.70 |
| 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 |
$951.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$612.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,268.80
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$432.98
|
|
|
INJECT JOINT MED
|
Facility
|
IP
|
$946.00
|
|
| Hospital Charge Code |
2407185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.26 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$804.10
|
| Rate for Payer: First Health Commercial |
$851.40
|
| Rate for Payer: First Health Workers Compensation |
$365.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$851.40
|
| Rate for Payer: GEHA Commercial |
$662.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$851.40
|
| Rate for Payer: Multiplan All |
$860.86
|
| Rate for Payer: OMNI Networks Commercial |
$662.20
|
| Rate for Payer: One Health Plan PPO/POS |
$851.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$898.70
|
| Rate for Payer: Three Rivers Provider Network All |
$709.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$879.78
|
| Rate for Payer: Zelis Auto |
$378.40
|
| Rate for Payer: Zelis Worker's Compensation |
$258.26
|
|
|
INJECT JOINT MED
|
Facility
|
OP
|
$946.00
|
|
| Hospital Charge Code |
2407185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.50 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$804.10
|
| Rate for Payer: First Health Commercial |
$851.40
|
| Rate for Payer: First Health Workers Compensation |
$365.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$851.40
|
| Rate for Payer: GEHA Commercial |
$756.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$851.40
|
| Rate for Payer: Humana ChoiceCare |
$245.96
|
| Rate for Payer: Multiplan All |
$860.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$567.60
|
| Rate for Payer: OMNI Networks Commercial |
$662.20
|
| Rate for Payer: One Health Plan PPO/POS |
$851.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$898.70
|
| Rate for Payer: Three Rivers Provider Network All |
$709.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$832.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$236.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$879.78
|
| Rate for Payer: Zelis Auto |
$378.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$473.00
|
| Rate for Payer: Zelis Worker's Compensation |
$258.26
|
|
|
INJECT JOINT SMALL
|
Facility
|
IP
|
$1,246.00
|
|
| Hospital Charge Code |
2407186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$872.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Worker's Compensation |
$340.16
|
|
|
INJECT JOINT SMALL
|
Facility
|
OP
|
$1,246.00
|
|
| Hospital Charge Code |
2407186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Humana ChoiceCare |
$323.96
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$747.60
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,096.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$311.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$623.00
|
| Rate for Payer: Zelis Worker's Compensation |
$340.16
|
|
|
INJECT SINUS TRACT FOR X-RAY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
6120501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$46.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.76
|
|
|
INJECT SINUS TRACT FOR X-RAY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
6120501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$46.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$31.20
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.00
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$105.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.76
|
|
|
INJ FOR SIALOGRAPHY
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
2407255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$828.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cigna Commercial |
$741.20
|
| Rate for Payer: First Health Commercial |
$784.80
|
| Rate for Payer: First Health Workers Compensation |
$336.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$784.80
|
| Rate for Payer: GEHA Commercial |
$697.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$784.80
|
| Rate for Payer: Humana ChoiceCare |
$226.72
|
| Rate for Payer: Multiplan All |
$793.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$523.20
|
| Rate for Payer: OMNI Networks Commercial |
$610.40
|
| Rate for Payer: One Health Plan PPO/POS |
$784.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$828.40
|
| Rate for Payer: Three Rivers Provider Network All |
$654.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$767.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.96
|
| Rate for Payer: Zelis Auto |
$348.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$436.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.06
|
|
|
INJ FOR SIALOGRAPHY
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
2407255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.06 |
| Max. Negotiated Rate |
$828.40 |
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cigna Commercial |
$741.20
|
| Rate for Payer: First Health Commercial |
$784.80
|
| Rate for Payer: First Health Workers Compensation |
$336.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$784.80
|
| Rate for Payer: GEHA Commercial |
$610.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$784.80
|
| Rate for Payer: Multiplan All |
$793.52
|
| Rate for Payer: OMNI Networks Commercial |
$610.40
|
| Rate for Payer: One Health Plan PPO/POS |
$784.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$828.40
|
| Rate for Payer: Three Rivers Provider Network All |
$654.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.96
|
| Rate for Payer: Zelis Auto |
$348.80
|
| Rate for Payer: Zelis Worker's Compensation |
$238.06
|
|
|
INJ IMMUNIZATION
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6180036
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$59.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$107.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Worker's Compensation |
$41.77
|
|
|
INJ IMMUNIZATION
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6180036
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$68.96
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$59.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$122.40
|
| Rate for Payer: GEHA Medicare |
$68.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Humana ChoiceCare |
$75.86
|
| Rate for Payer: Humana Medicare Advantage |
$68.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$115.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$68.96
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.23
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$68.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$137.92
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$67.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$68.96
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Medicare |
$58.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.75
|
| Rate for Payer: Zelis Worker's Compensation |
$41.77
|
|
|
INJ MEDROXYPROGESTERNE ACETATE 1 MG
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
8501050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
|
