|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
1929425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: First Health Workers Compensation |
$271.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$191.65
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
6129425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
9629425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$657.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$415.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cigna Commercial |
$588.20
|
| Rate for Payer: First Health Commercial |
$622.80
|
| Rate for Payer: First Health Workers Compensation |
$267.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$622.80
|
| Rate for Payer: GEHA Commercial |
$553.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$622.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$629.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$484.40
|
| Rate for Payer: One Health Plan PPO/POS |
$622.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$657.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$519.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$643.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$276.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$188.92
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
20300113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
1929425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.65 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: First Health Workers Compensation |
$271.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Worker's Compensation |
$191.65
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
8729425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
8229425
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
20300113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
8729425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG CAST WALKING/AMBUL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
8229425
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$640.50
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9629515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$608.48 |
| 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 |
$384.30
|
| 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 |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$544.42
|
| Rate for Payer: First Health Commercial |
$576.45
|
| Rate for Payer: First Health Workers Compensation |
$247.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.45
|
| Rate for Payer: GEHA Commercial |
$512.40
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.45
|
| 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 |
$582.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$448.35
|
| Rate for Payer: One Health Plan PPO/POS |
$576.45
|
| 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 |
$608.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$480.38
|
| 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 |
$595.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$256.20
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$174.86
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8829515
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8229515
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$299.66 |
| 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 |
$130.80
|
| 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 |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| 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 |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| 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 |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| 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 |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$640.50
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9629515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.86 |
| Max. Negotiated Rate |
$608.48 |
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$544.42
|
| Rate for Payer: First Health Commercial |
$576.45
|
| Rate for Payer: First Health Workers Compensation |
$247.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.45
|
| Rate for Payer: GEHA Commercial |
$448.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.45
|
| Rate for Payer: Multiplan All |
$582.86
|
| Rate for Payer: OMNI Networks Commercial |
$448.35
|
| Rate for Payer: One Health Plan PPO/POS |
$576.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.48
|
| Rate for Payer: Three Rivers Provider Network All |
$480.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.66
|
| Rate for Payer: Zelis Auto |
$256.20
|
| Rate for Payer: Zelis Worker's Compensation |
$174.86
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8150058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8229515
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8729515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
6112058
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$699.20 |
| 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 |
$441.60
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$192.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| 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 |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| 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 |
$699.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| 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 |
$684.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$136.35
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
1929515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$620.35 |
| 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 |
$391.80
|
| 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 |
$391.80
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cigna Commercial |
$555.05
|
| Rate for Payer: First Health Commercial |
$587.70
|
| Rate for Payer: First Health Workers Compensation |
$252.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$587.70
|
| Rate for Payer: GEHA Commercial |
$522.40
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$587.70
|
| 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 |
$594.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$457.10
|
| Rate for Payer: One Health Plan PPO/POS |
$587.70
|
| 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 |
$620.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$489.75
|
| 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 |
$607.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$261.20
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$178.27
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
6112058
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8829515
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$299.66 |
| 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 |
$130.80
|
| 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 |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| 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 |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| 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 |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| 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 |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
1929515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.27 |
| Max. Negotiated Rate |
$620.35 |
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cigna Commercial |
$555.05
|
| Rate for Payer: First Health Commercial |
$587.70
|
| Rate for Payer: First Health Workers Compensation |
$252.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$587.70
|
| Rate for Payer: GEHA Commercial |
$457.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$587.70
|
| Rate for Payer: Multiplan All |
$594.23
|
| Rate for Payer: OMNI Networks Commercial |
$457.10
|
| Rate for Payer: One Health Plan PPO/POS |
$587.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$620.35
|
| Rate for Payer: Three Rivers Provider Network All |
$489.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$607.29
|
| Rate for Payer: Zelis Auto |
$261.20
|
| Rate for Payer: Zelis Worker's Compensation |
$178.27
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8150058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$699.20 |
| 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 |
$441.60
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| 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 |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| 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 |
$699.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| 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 |
$684.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
21600153
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$299.66 |
| 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 |
$130.80
|
| 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 |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| 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 |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| 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 |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| 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 |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
APPLICATION SHORT LEG SPLINT CALF FOOT
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
8729515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$299.66 |
| 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 |
$130.80
|
| 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 |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| 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 |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| 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 |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| 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 |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
