|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8220552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| 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 |
$99.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| 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 |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| 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 |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
25500029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.59 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$64.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$116.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Worker's Compensation |
$45.59
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
7620552
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
21720552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| 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 |
$99.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| 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 |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| 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 |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
25500029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.59 |
| 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 |
$100.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$64.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$133.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| 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 |
$151.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| 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 |
$158.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| 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 |
$155.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.59
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
21600029
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$45.59 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$64.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$116.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Worker's Compensation |
$45.59
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
21900144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| 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 |
$99.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| 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 |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| 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 |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
8120552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$850.00
|
| Rate for Payer: First Health Commercial |
$900.00
|
| Rate for Payer: First Health Workers Compensation |
$386.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.00
|
| Rate for Payer: GEHA Commercial |
$700.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.00
|
| Rate for Payer: Multiplan All |
$910.00
|
| Rate for Payer: OMNI Networks Commercial |
$700.00
|
| Rate for Payer: One Health Plan PPO/POS |
$900.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.00
|
| Rate for Payer: Three Rivers Provider Network All |
$750.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.00
|
| Rate for Payer: Zelis Auto |
$400.00
|
| Rate for Payer: Zelis Worker's Compensation |
$273.00
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
6120552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$101.15
|
| Rate for Payer: First Health Commercial |
$107.10
|
| Rate for Payer: First Health Workers Compensation |
$45.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$107.10
|
| Rate for Payer: GEHA Commercial |
$83.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$107.10
|
| Rate for Payer: Multiplan All |
$108.29
|
| Rate for Payer: OMNI Networks Commercial |
$83.30
|
| Rate for Payer: One Health Plan PPO/POS |
$107.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$113.05
|
| Rate for Payer: Three Rivers Provider Network All |
$89.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$110.67
|
| Rate for Payer: Zelis Auto |
$47.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.49
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
6120552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$32.49 |
| 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 |
$71.40
|
| 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 |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$101.15
|
| Rate for Payer: First Health Commercial |
$107.10
|
| Rate for Payer: First Health Workers Compensation |
$45.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$107.10
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$107.10
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$108.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$83.30
|
| Rate for Payer: One Health Plan PPO/POS |
$107.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$113.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$89.25
|
| 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 |
$110.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$47.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$32.49
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$146.01
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
7220552
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$138.71 |
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cigna Commercial |
$124.11
|
| Rate for Payer: First Health Commercial |
$131.41
|
| Rate for Payer: First Health Workers Compensation |
$56.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.41
|
| Rate for Payer: GEHA Commercial |
$102.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.41
|
| Rate for Payer: Multiplan All |
$132.87
|
| Rate for Payer: OMNI Networks Commercial |
$102.21
|
| Rate for Payer: One Health Plan PPO/POS |
$131.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$138.71
|
| Rate for Payer: Three Rivers Provider Network All |
$109.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$135.79
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Worker's Compensation |
$39.86
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
8120552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$850.00
|
| Rate for Payer: First Health Commercial |
$900.00
|
| Rate for Payer: First Health Workers Compensation |
$386.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.00
|
| Rate for Payer: GEHA Commercial |
$800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.00
|
| Rate for Payer: Humana ChoiceCare |
$260.00
|
| Rate for Payer: Multiplan All |
$910.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$600.00
|
| Rate for Payer: OMNI Networks Commercial |
$700.00
|
| Rate for Payer: One Health Plan PPO/POS |
$900.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.00
|
| Rate for Payer: Three Rivers Provider Network All |
$750.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$880.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$250.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.00
|
| Rate for Payer: Zelis Auto |
$400.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$500.00
|
| Rate for Payer: Zelis Worker's Compensation |
$273.00
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
21600029
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$45.59 |
| 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 |
$100.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$64.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$133.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| 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 |
$151.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| 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 |
$158.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| 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 |
$155.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.59
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
21720552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
7620552
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.32 |
| 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 |
$99.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| 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 |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| 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 |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
21900144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$146.01
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8520552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$138.71 |
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cigna Commercial |
$124.11
|
| Rate for Payer: First Health Commercial |
$131.41
|
| Rate for Payer: First Health Workers Compensation |
$56.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.41
|
| Rate for Payer: GEHA Commercial |
$102.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.41
|
| Rate for Payer: Multiplan All |
$132.87
|
| Rate for Payer: OMNI Networks Commercial |
$102.21
|
| Rate for Payer: One Health Plan PPO/POS |
$131.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$138.71
|
| Rate for Payer: Three Rivers Provider Network All |
$109.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$135.79
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Worker's Compensation |
$39.86
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8220552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8820552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| 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 |
$99.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| 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 |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| 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 |
$154.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8820552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$146.01
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
7220552
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$39.86 |
| 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 |
$87.61
|
| 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 |
$87.61
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cigna Commercial |
$124.11
|
| Rate for Payer: First Health Commercial |
$131.41
|
| Rate for Payer: First Health Workers Compensation |
$56.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.41
|
| Rate for Payer: GEHA Commercial |
$116.81
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.41
|
| 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 |
$132.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$102.21
|
| Rate for Payer: One Health Plan PPO/POS |
$131.41
|
| 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 |
$138.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$109.51
|
| 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 |
$135.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$39.86
|
|
|
INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Facility
|
OP
|
$146.01
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
8520552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.86 |
| 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 |
$87.61
|
| 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 |
$87.61
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cigna Commercial |
$124.11
|
| Rate for Payer: First Health Commercial |
$131.41
|
| Rate for Payer: First Health Workers Compensation |
$56.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.41
|
| Rate for Payer: GEHA Commercial |
$116.81
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.41
|
| 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 |
$132.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$102.21
|
| Rate for Payer: One Health Plan PPO/POS |
$131.41
|
| 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 |
$138.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$109.51
|
| 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 |
$135.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$39.86
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
IP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8204025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$159.83 |
| Rate for Payer: Cash Price |
$100.94
|
| Rate for Payer: Cigna Commercial |
$143.00
|
| Rate for Payer: First Health Commercial |
$151.42
|
| Rate for Payer: First Health Workers Compensation |
$64.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.42
|
| Rate for Payer: GEHA Commercial |
$117.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| Rate for Payer: Multiplan All |
$153.10
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.83
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.46
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
IP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8800044
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$159.83 |
| Rate for Payer: Cash Price |
$100.94
|
| Rate for Payer: Cigna Commercial |
$143.00
|
| Rate for Payer: First Health Commercial |
$151.42
|
| Rate for Payer: First Health Workers Compensation |
$64.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.42
|
| Rate for Payer: GEHA Commercial |
$117.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| Rate for Payer: Multiplan All |
$153.10
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.83
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.46
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
9620553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,088.70 |
| 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 |
$687.60
|
| 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 |
$280.29
|
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Cash Price |
$687.60
|
| Rate for Payer: Cigna Commercial |
$974.10
|
| Rate for Payer: First Health Commercial |
$1,031.40
|
| Rate for Payer: First Health Workers Compensation |
$442.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,031.40
|
| Rate for Payer: GEHA Commercial |
$916.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,031.40
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$1,042.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$802.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,031.40
|
| 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 |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,088.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$859.50
|
| 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 |
$1,065.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$458.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$312.86
|
|
