|
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: 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
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
INJ METHYLPRDNISLN SODIM TO 125 MG
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
8502930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$25.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$8.32
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.20
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
INJ METHYLPRDNISLN SODIM TO 125 MG
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
8502930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$12.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.74
|
|
|
INJ METHYLPRDNISOLONE ACTAT 20 MG
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
8501020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$13.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$4.42
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.20
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
INJ METHYLPRDNISOLONE ACTAT 20 MG
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
8501020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$14.45
|
| Rate for Payer: First Health Commercial |
$15.30
|
| Rate for Payer: First Health Workers Compensation |
$6.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15.30
|
| Rate for Payer: GEHA Commercial |
$11.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15.30
|
| Rate for Payer: Multiplan All |
$15.47
|
| Rate for Payer: OMNI Networks Commercial |
$11.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16.15
|
| Rate for Payer: Three Rivers Provider Network All |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15.81
|
| Rate for Payer: Zelis Auto |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.64
|
|
|
INJ METHYLPRDNISOLON SODIM TO 40 MG
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
8502920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJ METHYLPRDNISOLON SODIM TO 40 MG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
8502920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJ PCN G BENZATHINE TO 2400000 U
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
8500580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$60.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$30.01
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$33.01
|
| Rate for Payer: GEHA Medicare |
$30.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$33.01
|
| Rate for Payer: Humana Medicare Advantage |
$30.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$50.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$30.01
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$51.02
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$30.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$60.02
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$30.01
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$25.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$36.01
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJ PCN G BENZATHINE TO 2400000 U
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
8500580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJ PCN G BENZ & PROCAINE 100000 U
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT J0558
|
| Hospital Charge Code |
8500558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$21.47
|
| Rate for Payer: GEHA Medicare |
$19.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$21.47
|
| Rate for Payer: Humana Medicare Advantage |
$19.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.52
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33.18
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.04
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.52
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Medicare |
$16.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.42
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
INJ PCN G BENZ & PROCAINE 100000 U
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT J0558
|
| Hospital Charge Code |
8500558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
INJ SHLDR CT/MRI ART
|
Facility
|
OP
|
$570.00
|
|
| Hospital Charge Code |
2467178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: First Health Workers Compensation |
$220.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$456.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Humana ChoiceCare |
$148.20
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.00
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$501.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.00
|
| Rate for Payer: Zelis Worker's Compensation |
$155.61
|
|
|
INJ SHLDR CT/MRI ART
|
Facility
|
IP
|
$570.00
|
|
| Hospital Charge Code |
2467178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: First Health Workers Compensation |
$220.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$399.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Worker's Compensation |
$155.61
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
21900146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.22 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
7600260
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$130.22 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
21900146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
21727096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
21727096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.22 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
7600260
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
7627096
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
6127096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
6127096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$130.22 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JOINT ARTHRGRPHY&/ANES/STRD W/IMA
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
7627096
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$130.22 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
INJ SI JT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
6100009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$426.97 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: First Health Commercial |
$1,407.60
|
| Rate for Payer: First Health Workers Compensation |
$603.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,407.60
|
| Rate for Payer: GEHA Commercial |
$1,094.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,407.60
|
| Rate for Payer: Multiplan All |
$1,423.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,407.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,485.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,454.52
|
| Rate for Payer: Zelis Auto |
$625.60
|
| Rate for Payer: Zelis Worker's Compensation |
$426.97
|
|
|
INJ SI JT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
6100009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$338.31 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$938.40
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: First Health Commercial |
$1,407.60
|
| Rate for Payer: First Health Workers Compensation |
$478.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,407.60
|
| Rate for Payer: GEHA Commercial |
$1,251.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$406.64
|
| Rate for Payer: Multiplan All |
$1,423.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$938.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,407.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,485.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,376.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,454.52
|
| Rate for Payer: Zelis Auto |
$625.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$782.00
|
| Rate for Payer: Zelis Worker's Compensation |
$338.31
|
|
