|
APLIGRAFT 44 SQ CM
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
1999234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.22
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: First Health Workers Compensation |
$507.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$33.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Humana ChoiceCare |
$341.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.96
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$788.40
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,156.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$657.00
|
| Rate for Payer: Zelis Worker's Compensation |
$358.72
|
|
|
apl (pml-rara) quant REF510840
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
2200001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.21 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$373.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$627.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$373.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$295.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$207.31
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: First Health Workers Compensation |
$310.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$836.00
|
| Rate for Payer: GEHA Medicare |
$207.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Humana ChoiceCare |
$228.04
|
| Rate for Payer: Humana Medicare Advantage |
$207.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$348.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$301.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$207.31
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.43
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$348.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$301.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$207.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$414.62
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$203.16
|
| Rate for Payer: United Healthcare Commercial |
$888.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$207.31
|
| Rate for Payer: Zelis Auto |
$418.00
|
| Rate for Payer: Zelis Medicare |
$176.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$248.77
|
| Rate for Payer: Zelis Worker's Compensation |
$219.84
|
|
|
apl (pml-rara) quant REF510840
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
2200001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.84 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: First Health Workers Compensation |
$310.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$731.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: Zelis Auto |
$418.00
|
| Rate for Payer: Zelis Worker's Compensation |
$219.84
|
|
|
apolipoprotein a-1 REF016873
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
2200675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$27.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$21.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$23.20
|
| Rate for Payer: Humana Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.09
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.85
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42.18
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.67
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.09
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$17.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.31
|
| Rate for Payer: Zelis Worker's Compensation |
$19.65
|
|
|
apolipoprotein a-1 REF016873
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
2200675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$27.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.65
|
|
|
apolipoprotein B REF167015
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
2299680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$27.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$21.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$23.20
|
| Rate for Payer: Humana Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.09
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.85
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42.18
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.67
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.09
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$17.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.31
|
| Rate for Payer: Zelis Worker's Compensation |
$19.65
|
|
|
apolipoprotein B REF167015
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
2299680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$27.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.65
|
|
|
APPENDECTOMY
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
CPT 44960
|
| Hospital Charge Code |
6144960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cigna Commercial |
$1,564.00
|
| Rate for Payer: First Health Commercial |
$1,656.00
|
| Rate for Payer: First Health Workers Compensation |
$710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,656.00
|
| Rate for Payer: GEHA Commercial |
$1,288.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,656.00
|
| Rate for Payer: Multiplan All |
$1,674.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,288.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,656.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,748.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,380.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,711.20
|
| Rate for Payer: Zelis Auto |
$736.00
|
| Rate for Payer: Zelis Worker's Compensation |
$502.32
|
|
|
APPENDECTOMY
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
6144950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.10 |
| Max. Negotiated Rate |
$11,849.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,177.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,924.89
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cigna Commercial |
$1,149.20
|
| Rate for Payer: First Health Commercial |
$1,216.80
|
| Rate for Payer: First Health Workers Compensation |
$522.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,216.80
|
| Rate for Payer: GEHA Commercial |
$1,081.60
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,216.80
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,221.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: Multiplan All |
$1,230.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: OMNI Networks Commercial |
$946.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,216.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,565.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,221.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,284.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,257.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Auto |
$540.80
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$369.10
|
|
|
APPENDECTOMY
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
CPT 44960
|
| Hospital Charge Code |
6144960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cigna Commercial |
$1,564.00
|
| Rate for Payer: First Health Commercial |
$1,656.00
|
| Rate for Payer: First Health Workers Compensation |
$710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,656.00
|
| Rate for Payer: GEHA Commercial |
$1,472.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,656.00
|
| Rate for Payer: Humana ChoiceCare |
$478.40
|
| Rate for Payer: Multiplan All |
$1,674.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,104.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,288.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,656.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,748.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,619.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$460.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,711.20
|
| Rate for Payer: Zelis Auto |
$736.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$920.00
|
| Rate for Payer: Zelis Worker's Compensation |
$502.32
|
|
|
APPENDECTOMY
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
6144950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.10 |
| Max. Negotiated Rate |
$1,284.40 |
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cigna Commercial |
$1,149.20
|
| Rate for Payer: First Health Commercial |
$1,216.80
|
| Rate for Payer: First Health Workers Compensation |
$522.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,216.80
|
| Rate for Payer: GEHA Commercial |
$946.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,216.80
|
| Rate for Payer: Multiplan All |
$1,230.32
|
| Rate for Payer: OMNI Networks Commercial |
$946.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,216.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,284.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,257.36
|
| Rate for Payer: Zelis Auto |
$540.80
|
| Rate for Payer: Zelis Worker's Compensation |
$369.10
|
|
|
APPENDECTOMY ADD-ON
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
6144955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$103.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$69.68
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.80
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$235.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.16
|
|
|
APPENDECTOMY ADD-ON
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
6144955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$103.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.16
|
|
|
APPENDICO-VESICOSTOMY
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 50845
|
| Hospital Charge Code |
6150845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$703.79 |
| Max. Negotiated Rate |
$2,449.10 |
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Cigna Commercial |
$2,191.30
|
| Rate for Payer: First Health Commercial |
$2,320.20
|
| Rate for Payer: First Health Workers Compensation |
$995.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,320.20
|
| Rate for Payer: GEHA Commercial |
$1,804.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,320.20
|
| Rate for Payer: Multiplan All |
$2,345.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,804.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,320.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,449.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,933.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,397.54
|
| Rate for Payer: Zelis Auto |
$1,031.20
|
| Rate for Payer: Zelis Worker's Compensation |
$703.79
|
|
|
APPENDICO-VESICOSTOMY
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 50845
|
| Hospital Charge Code |
6150845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$644.50 |
| Max. Negotiated Rate |
$2,449.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,546.80
|
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Cigna Commercial |
$2,191.30
|
| Rate for Payer: First Health Commercial |
$2,320.20
|
| Rate for Payer: First Health Workers Compensation |
$995.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,320.20
|
| Rate for Payer: GEHA Commercial |
$2,062.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,320.20
|
| Rate for Payer: Humana ChoiceCare |
$670.28
|
| Rate for Payer: Multiplan All |
$2,345.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,546.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,804.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,320.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,449.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,933.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,268.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$644.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,397.54
|
| Rate for Payer: Zelis Auto |
$1,031.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,289.00
|
| Rate for Payer: Zelis Worker's Compensation |
$703.79
|
|
|
APPL CLUBFOOT CAST MOLD/MAN LNG/SHRT LEG
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
9629450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
APPL CLUBFOOT CAST MOLD/MAN LNG/SHRT LEG
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
8729450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
APPL CLUBFOOT CAST MOLD/MAN LNG/SHRT LEG
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
8229450
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
APPL CLUBFOOT CAST MOLD/MAN LNG/SHRT LEG
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
9629450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.45 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
APPL CLUBFOOT CAST MOLD/MAN LNG/SHRT LEG
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
8729450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
APPL CLUBFOOT CAST MOLD/MAN LNG/SHRT LEG
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
8229450
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
APPLICATION FINGER SPLINT STATIC
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
8229130
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
APPLICATION FINGER SPLINT STATIC
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
8150056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.51 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: First Health Workers Compensation |
$71.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$129.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
| Rate for Payer: Zelis Worker's Compensation |
$50.51
|
|
|
APPLICATION FINGER SPLINT STATIC
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
8229130
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
APPLICATION FINGER SPLINT STATIC
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
21600150
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
