|
SHORTENING OF HAND TENDON
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 26479
|
| Hospital Charge Code |
6126479
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.15 |
| Max. Negotiated Rate |
$1,141.90 |
| Rate for Payer: Cash Price |
$721.20
|
| Rate for Payer: Cigna Commercial |
$1,021.70
|
| Rate for Payer: First Health Commercial |
$1,081.80
|
| Rate for Payer: First Health Workers Compensation |
$464.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,081.80
|
| Rate for Payer: GEHA Commercial |
$841.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,081.80
|
| Rate for Payer: Multiplan All |
$1,093.82
|
| Rate for Payer: OMNI Networks Commercial |
$841.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,081.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,141.90
|
| Rate for Payer: Three Rivers Provider Network All |
$901.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,117.86
|
| Rate for Payer: Zelis Auto |
$480.80
|
| Rate for Payer: Zelis Worker's Compensation |
$328.15
|
|
|
SHORTENING OF THIGH BONE
|
Facility
|
OP
|
$2,553.00
|
|
|
Service Code
|
CPT 27465
|
| Hospital Charge Code |
6127465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.25 |
| Max. Negotiated Rate |
$2,425.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,531.80
|
| Rate for Payer: Cash Price |
$1,531.80
|
| Rate for Payer: Cigna Commercial |
$2,170.05
|
| Rate for Payer: First Health Commercial |
$2,297.70
|
| Rate for Payer: First Health Workers Compensation |
$985.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,297.70
|
| Rate for Payer: GEHA Commercial |
$2,042.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,297.70
|
| Rate for Payer: Humana ChoiceCare |
$663.78
|
| Rate for Payer: Multiplan All |
$2,323.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,531.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,787.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,425.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,914.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,246.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$638.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,374.29
|
| Rate for Payer: Zelis Auto |
$1,021.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,276.50
|
| Rate for Payer: Zelis Worker's Compensation |
$696.97
|
|
|
SHORTENING OF THIGH BONE
|
Facility
|
IP
|
$2,553.00
|
|
|
Service Code
|
CPT 27465
|
| Hospital Charge Code |
6127465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$696.97 |
| Max. Negotiated Rate |
$2,425.35 |
| Rate for Payer: Cash Price |
$1,531.80
|
| Rate for Payer: Cigna Commercial |
$2,170.05
|
| Rate for Payer: First Health Commercial |
$2,297.70
|
| Rate for Payer: First Health Workers Compensation |
$985.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,297.70
|
| Rate for Payer: GEHA Commercial |
$1,787.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,297.70
|
| Rate for Payer: Multiplan All |
$2,323.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,787.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,425.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,914.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,374.29
|
| Rate for Payer: Zelis Auto |
$1,021.20
|
| Rate for Payer: Zelis Worker's Compensation |
$696.97
|
|
|
SHORTEN/LENGTHEN THIGHS
|
Facility
|
IP
|
$2,546.00
|
|
|
Service Code
|
CPT 27468
|
| Hospital Charge Code |
6127468
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$695.06 |
| Max. Negotiated Rate |
$2,418.70 |
| Rate for Payer: Cash Price |
$1,527.60
|
| Rate for Payer: Cigna Commercial |
$2,164.10
|
| Rate for Payer: First Health Commercial |
$2,291.40
|
| Rate for Payer: First Health Workers Compensation |
$983.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,291.40
|
| Rate for Payer: GEHA Commercial |
$1,782.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,291.40
|
| Rate for Payer: Multiplan All |
$2,316.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,782.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,291.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,418.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,909.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,367.78
|
| Rate for Payer: Zelis Auto |
$1,018.40
|
| Rate for Payer: Zelis Worker's Compensation |
$695.06
|
|
|
SHORTEN/LENGTHEN THIGHS
|
Facility
|
OP
|
$2,546.00
|
|
|
Service Code
|
CPT 27468
|
| Hospital Charge Code |
6127468
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$636.50 |
| Max. Negotiated Rate |
$2,418.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,527.60
|
| Rate for Payer: Cash Price |
$1,527.60
|
| Rate for Payer: Cigna Commercial |
$2,164.10
|
| Rate for Payer: First Health Commercial |
$2,291.40
|
| Rate for Payer: First Health Workers Compensation |
$983.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,291.40
|
| Rate for Payer: GEHA Commercial |
$2,036.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,291.40
|
| Rate for Payer: Humana ChoiceCare |
$661.96
|
| Rate for Payer: Multiplan All |
$2,316.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,527.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,782.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,291.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,418.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,909.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,240.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$636.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,367.78
|
| Rate for Payer: Zelis Auto |
$1,018.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,273.00
|
| Rate for Payer: Zelis Worker's Compensation |
$695.06
|
|
|
SHORTEN RADIUS OR ULNA
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 25390
|
| Hospital Charge Code |
6125390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$428.88 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,335.35
|
| Rate for Payer: First Health Commercial |
$1,413.90
|
| Rate for Payer: First Health Workers Compensation |
$606.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,413.90
|
| Rate for Payer: GEHA Commercial |
$1,099.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,413.90
|
| Rate for Payer: Multiplan All |
$1,429.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,099.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,413.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,492.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,178.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,461.03
|
| Rate for Payer: Zelis Auto |
$628.40
|
| Rate for Payer: Zelis Worker's Compensation |
$428.88
|
|
|
SHORTEN RADIUS OR ULNA
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 25390
|
| Hospital Charge Code |
6125390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$428.88 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$942.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,335.35
|
| Rate for Payer: First Health Commercial |
$1,413.90
|
| Rate for Payer: First Health Workers Compensation |
$606.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,413.90
|
| Rate for Payer: GEHA Commercial |
$1,256.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,413.90
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,429.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,099.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,413.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,492.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,178.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,461.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$628.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$428.88
|
|
|
SHORTEN RADIUS & ULNA
|
Facility
|
IP
|
$1,789.00
|
|
|
Service Code
|
CPT 25392
|
| Hospital Charge Code |
6125392
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$1,520.65
|
| Rate for Payer: First Health Commercial |
$1,610.10
|
| Rate for Payer: First Health Workers Compensation |
$690.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,610.10
|
| Rate for Payer: GEHA Commercial |
$1,252.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,610.10
|
| Rate for Payer: Multiplan All |
$1,627.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,252.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,610.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,699.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,341.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,663.77
|
| Rate for Payer: Zelis Auto |
$715.60
|
| Rate for Payer: Zelis Worker's Compensation |
$488.40
|
|
|
SHORTEN RADIUS & ULNA
|
Facility
|
OP
|
$1,789.00
|
|
|
Service Code
|
CPT 25392
|
| Hospital Charge Code |
6125392
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,073.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$1,520.65
|
| Rate for Payer: First Health Commercial |
$1,610.10
|
| Rate for Payer: First Health Workers Compensation |
$690.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,610.10
|
| Rate for Payer: GEHA Commercial |
$1,431.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,610.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,627.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,252.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,610.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,699.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,341.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,663.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$715.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$488.40
|
|
|
SHORT LEG CAST, ADULT (11+YRS)
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
8804038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
SHORT LEG CAST, ADULT (11+YRS)
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
8804038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
SHORT LEG CAST, ADULT (11+YRS)
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
8204038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
SHORT LEG CAST, ADULT (11+YRS)
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
8204038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
SHORT LEG CAST, PED (0-10 YRS)
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT Q4040
|
| Hospital Charge Code |
8204040
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
SHORT LEG CAST, PED (0-10 YRS)
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT Q4040
|
| Hospital Charge Code |
8204040
|
|
Hospital Revenue Code
|
270
|
| 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: 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 |
$52.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$58.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
SHORT LEG CAST, PED (0-10 YRS)
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT Q4040
|
| Hospital Charge Code |
8804040
|
|
Hospital Revenue Code
|
270
|
| 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: 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 |
$52.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$58.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
SHORT LEG CAST, PED (0-10 YRS)
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT Q4040
|
| Hospital Charge Code |
8804040
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
SHORT LEG SPLINT, ADULT (11+YRS)
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
8204047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$42.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
SHORT LEG SPLINT, ADULT (11+YRS)
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
8804046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$48.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Humana ChoiceCare |
$15.86
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$53.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
SHORT LEG SPLINT, ADULT (11+YRS)
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
8804046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$42.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
SHORT LEG SPLINT, ADULT (11+YRS)
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
8204047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$48.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Humana ChoiceCare |
$15.86
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$53.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
SHORT LEG SPLINT, PED (0-10 YRS)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
8804048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
SHORT LEG SPLINT, PED (0-10 YRS)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
8204048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
SHORT LEG SPLINT, PED (0-10 YRS)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
8804048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
SHORT LEG SPLINT, PED (0-10 YRS)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
8204048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
