|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
IP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
7620553
|
|
Hospital Revenue Code
|
983
|
| 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
|
$1,146.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
9620553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.86 |
| Max. Negotiated Rate |
$1,088.70 |
| 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 |
$802.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,031.40
|
| Rate for Payer: Multiplan All |
$1,042.86
|
| Rate for Payer: OMNI Networks Commercial |
$802.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,031.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,088.70
|
| Rate for Payer: Three Rivers Provider Network All |
$859.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,065.78
|
| Rate for Payer: Zelis Auto |
$458.40
|
| Rate for Payer: Zelis Worker's Compensation |
$312.86
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
OP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8120553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
IP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8520553
|
|
Hospital Revenue Code
|
521
|
| 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
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
21900145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
IP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
7220553
|
|
Hospital Revenue Code
|
517
|
| 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
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8800044
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
IP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8720553
|
|
Hospital Revenue Code
|
510
|
| 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 |
21900145
|
|
Hospital Revenue Code
|
510
|
| 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 |
8120553
|
|
Hospital Revenue Code
|
450
|
| 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
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8520553
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
OP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
7620553
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
OP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8204025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
OP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
8720553
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Facility
|
OP
|
$168.24
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
7220553
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$45.93 |
| 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 |
$100.94
|
| 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 |
$100.94
|
| 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 |
$134.59
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.42
|
| 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 |
$153.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$117.77
|
| Rate for Payer: One Health Plan PPO/POS |
$151.42
|
| 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 |
$159.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$126.18
|
| 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 |
$156.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$67.30
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$45.93
|
|
|
INJ SINUS TRACT
|
Facility
|
IP
|
$2,081.00
|
|
| Hospital Charge Code |
2407198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.11 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: First Health Workers Compensation |
$803.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Worker's Compensation |
$568.11
|
|
|
INJ SINUS TRACT
|
Facility
|
OP
|
$2,081.00
|
|
| Hospital Charge Code |
2407198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: First Health Workers Compensation |
$803.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
| Rate for Payer: Zelis Worker's Compensation |
$568.11
|
|
|
INJ, SQ/IM (NOT VACC)
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$137.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
INJ, SQ/IM (NOT VACC)
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$187.15 |
| 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 |
$118.20
|
| 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 |
$67.58
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$157.60
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| 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 |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
INJ, SQ/IM (NOT VACC)
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8900026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$184.30 |
| 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 |
$116.40
|
| 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 |
$67.58
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| 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 |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
INJ, SQ/IM (NOT VACC)
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
8900026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
INJ ST JNT W FLCTUS
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2401121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.63 |
| Max. Negotiated Rate |
$1,564.65 |
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$1,399.95
|
| Rate for Payer: First Health Commercial |
$1,482.30
|
| Rate for Payer: First Health Workers Compensation |
$635.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,482.30
|
| Rate for Payer: GEHA Commercial |
$1,152.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,482.30
|
| Rate for Payer: Multiplan All |
$1,498.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,152.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,482.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,564.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,235.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,531.71
|
| Rate for Payer: Zelis Auto |
$658.80
|
| Rate for Payer: Zelis Worker's Compensation |
$449.63
|
|
|
INJ ST JNT W FLCTUS
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2401121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$411.75 |
| Max. Negotiated Rate |
$1,564.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$988.20
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$1,399.95
|
| Rate for Payer: First Health Commercial |
$1,482.30
|
| Rate for Payer: First Health Workers Compensation |
$635.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,482.30
|
| Rate for Payer: GEHA Commercial |
$1,317.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,482.30
|
| Rate for Payer: Humana ChoiceCare |
$428.22
|
| Rate for Payer: Multiplan All |
$1,498.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,152.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,482.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,564.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,235.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,449.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$411.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,531.71
|
| Rate for Payer: Zelis Auto |
$658.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$823.50
|
| Rate for Payer: Zelis Worker's Compensation |
$449.63
|
|
|
INJ TETNS IMMUN GLOB HUMN TO 250 U
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT J1670
|
| Hospital Charge Code |
8501670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
INJ TETNS IMMUN GLOB HUMN TO 250 U
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT J1670
|
| Hospital Charge Code |
8501670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$1,186.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$488.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$488.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$387.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$593.00
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$652.30
|
| Rate for Payer: GEHA Medicare |
$593.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$652.30
|
| Rate for Payer: Humana Medicare Advantage |
$593.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$996.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$395.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$593.00
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,008.10
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$456.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$395.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,186.00
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$581.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$395.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$593.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$593.00
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Medicare |
$504.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
