|
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 SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
1929405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$421.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$592.50
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9629405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$562.88 |
| 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 |
$355.50
|
| 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 |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$503.62
|
| Rate for Payer: First Health Commercial |
$533.25
|
| Rate for Payer: First Health Workers Compensation |
$228.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$533.25
|
| Rate for Payer: GEHA Commercial |
$474.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$533.25
|
| 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 |
$539.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$414.75
|
| Rate for Payer: One Health Plan PPO/POS |
$533.25
|
| 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 |
$562.88
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$444.38
|
| 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 |
$551.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$237.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$161.75
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$592.50
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9629405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$562.88 |
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$503.62
|
| Rate for Payer: First Health Commercial |
$533.25
|
| Rate for Payer: First Health Workers Compensation |
$228.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$533.25
|
| Rate for Payer: GEHA Commercial |
$414.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$533.25
|
| Rate for Payer: Multiplan All |
$539.17
|
| Rate for Payer: OMNI Networks Commercial |
$414.75
|
| Rate for Payer: One Health Plan PPO/POS |
$533.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.88
|
| Rate for Payer: Three Rivers Provider Network All |
$444.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$551.02
|
| Rate for Payer: Zelis Auto |
$237.00
|
| Rate for Payer: Zelis Worker's Compensation |
$161.75
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
20300112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
1929405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$571.90 |
| 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 |
$361.20
|
| 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 |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| 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 |
$547.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| 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 |
$571.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| 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 |
$559.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
8729405
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.61 |
| 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 |
$146.40
|
| 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 |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| 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 |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| 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 |
$231.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| 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 |
$226.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
8229405
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
8729405
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
20300112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.61 |
| 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 |
$146.40
|
| 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 |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| 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 |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| 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 |
$231.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| 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 |
$226.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
APPLICATION SHRT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
8229405
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.61 |
| 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 |
$146.40
|
| 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 |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| 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 |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| 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 |
$231.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| 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 |
$226.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
OP
|
$189.78
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
7229125
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Cigna Commercial |
$161.31
|
| Rate for Payer: First Health Commercial |
$170.80
|
| Rate for Payer: First Health Workers Compensation |
$73.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.80
|
| Rate for Payer: GEHA Commercial |
$151.82
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.80
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$172.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$132.85
|
| Rate for Payer: One Health Plan PPO/POS |
$170.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.29
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$142.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$75.91
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$51.81
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
21600151
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$73.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Worker's Compensation |
$52.14
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
8150055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$99.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$205.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$70.16
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
OP
|
$189.78
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
8529125
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Cigna Commercial |
$161.31
|
| Rate for Payer: First Health Commercial |
$170.80
|
| Rate for Payer: First Health Workers Compensation |
$73.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.80
|
| Rate for Payer: GEHA Commercial |
$151.82
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.80
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$172.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$132.85
|
| Rate for Payer: One Health Plan PPO/POS |
$170.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.29
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$142.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$75.91
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$51.81
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
8229125
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$73.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Worker's Compensation |
$52.14
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
21600151
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$73.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$52.14
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
8150055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$99.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$179.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.16
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
IP
|
$189.78
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
8529125
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Cigna Commercial |
$161.31
|
| Rate for Payer: First Health Commercial |
$170.80
|
| Rate for Payer: First Health Workers Compensation |
$73.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.80
|
| Rate for Payer: GEHA Commercial |
$132.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.80
|
| Rate for Payer: Multiplan All |
$172.70
|
| Rate for Payer: OMNI Networks Commercial |
$132.85
|
| Rate for Payer: One Health Plan PPO/POS |
$170.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.29
|
| Rate for Payer: Three Rivers Provider Network All |
$142.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.50
|
| Rate for Payer: Zelis Auto |
$75.91
|
| Rate for Payer: Zelis Worker's Compensation |
$51.81
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
8229125
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: First Health Workers Compensation |
$73.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$52.14
|
|
|
APPLICAT SHRT ARM SPLINT FOREARM-HAND ST
|
Facility
|
IP
|
$189.78
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
7229125
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Cigna Commercial |
$161.31
|
| Rate for Payer: First Health Commercial |
$170.80
|
| Rate for Payer: First Health Workers Compensation |
$73.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.80
|
| Rate for Payer: GEHA Commercial |
$132.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.80
|
| Rate for Payer: Multiplan All |
$172.70
|
| Rate for Payer: OMNI Networks Commercial |
$132.85
|
| Rate for Payer: One Health Plan PPO/POS |
$170.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.29
|
| Rate for Payer: Three Rivers Provider Network All |
$142.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.50
|
| Rate for Payer: Zelis Auto |
$75.91
|
| Rate for Payer: Zelis Worker's Compensation |
$51.81
|
|
|
APPLIER ENDO CLIP 10MM
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7002524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.40 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,250.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: Zelis Auto |
$714.40
|
|
|
APPLIER ENDO CLIP 10MM
|
Facility
|
OP
|
$1,786.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7002524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.50 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,071.60
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,428.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Humana ChoiceCare |
$464.36
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,071.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,571.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$446.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: Zelis Auto |
$714.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$893.00
|
|
|
APPLIER LIGACLIP LARGE
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
90008645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$331.25 |
| Max. Negotiated Rate |
$1,258.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,126.25
|
| Rate for Payer: First Health Commercial |
$1,192.50
|
| Rate for Payer: First Health Workers Compensation |
$511.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,192.50
|
| Rate for Payer: GEHA Commercial |
$1,060.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,192.50
|
| Rate for Payer: Humana ChoiceCare |
$344.50
|
| Rate for Payer: Multiplan All |
$1,205.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$795.00
|
| Rate for Payer: OMNI Networks Commercial |
$927.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,192.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,258.75
|
| Rate for Payer: Three Rivers Provider Network All |
$993.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,166.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$331.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,232.25
|
| Rate for Payer: Zelis Auto |
$530.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$662.50
|
| Rate for Payer: Zelis Worker's Compensation |
$361.73
|
|
|
APPLIER LIGACLIP LARGE
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
90008645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$361.73 |
| Max. Negotiated Rate |
$1,258.75 |
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,126.25
|
| Rate for Payer: First Health Commercial |
$1,192.50
|
| Rate for Payer: First Health Workers Compensation |
$511.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,192.50
|
| Rate for Payer: GEHA Commercial |
$927.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,192.50
|
| Rate for Payer: Multiplan All |
$1,205.75
|
| Rate for Payer: OMNI Networks Commercial |
$927.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,192.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,258.75
|
| Rate for Payer: Three Rivers Provider Network All |
$993.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,232.25
|
| Rate for Payer: Zelis Auto |
$530.00
|
| Rate for Payer: Zelis Worker's Compensation |
$361.73
|
|
