|
APPLIER LIGACLIP MEDIUM
|
Facility
|
OP
|
$1,402.00
|
|
| Hospital Charge Code |
90008644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
APPLIER LIGACLIP MEDIUM
|
Facility
|
IP
|
$1,402.00
|
|
| Hospital Charge Code |
90008644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
APPLIER LIGACLIP SMALL
|
Facility
|
OP
|
$1,303.00
|
|
| Hospital Charge Code |
90008643
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$325.75 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$1,107.55
|
| Rate for Payer: First Health Commercial |
$1,172.70
|
| Rate for Payer: First Health Workers Compensation |
$503.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,172.70
|
| Rate for Payer: GEHA Commercial |
$1,042.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,172.70
|
| Rate for Payer: Humana ChoiceCare |
$338.78
|
| Rate for Payer: Multiplan All |
$1,185.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$781.80
|
| Rate for Payer: OMNI Networks Commercial |
$912.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,172.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,237.85
|
| Rate for Payer: Three Rivers Provider Network All |
$977.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,146.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$325.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,211.79
|
| Rate for Payer: Zelis Auto |
$521.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$651.50
|
| Rate for Payer: Zelis Worker's Compensation |
$355.72
|
|
|
APPLIER LIGACLIP SMALL
|
Facility
|
IP
|
$1,303.00
|
|
| Hospital Charge Code |
90008643
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$355.72 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$1,107.55
|
| Rate for Payer: First Health Commercial |
$1,172.70
|
| Rate for Payer: First Health Workers Compensation |
$503.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,172.70
|
| Rate for Payer: GEHA Commercial |
$912.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,172.70
|
| Rate for Payer: Multiplan All |
$1,185.73
|
| Rate for Payer: OMNI Networks Commercial |
$912.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,172.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,237.85
|
| Rate for Payer: Three Rivers Provider Network All |
$977.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,211.79
|
| Rate for Payer: Zelis Auto |
$521.20
|
| Rate for Payer: Zelis Worker's Compensation |
$355.72
|
|
|
APPL MLTLAYR COMPRES SYS UP/LW ARM HND&F
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 29584
|
| Hospital Charge Code |
1929584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.24 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| 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 |
$92.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$106.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$92.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
APPL MLTLAYR COMPRES SYS UP/LW ARM HND&F
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 29584
|
| Hospital Charge Code |
1929584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.22 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: First Health Workers Compensation |
$184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Worker's Compensation |
$130.22
|
|
|
APPL MLTLAYR COMPRES SYS UP/LW ARM HND/F
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 29584
|
| Hospital Charge Code |
8229584
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$187.20
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| 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 |
$92.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$106.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$92.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
APPL MLTLAYR COMPRES SYS UP/LW ARM HND/F
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 29584
|
| Hospital Charge Code |
8229584
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
APPL MLTLAYR COMPRS LEG BELOW KNEE W/ANK
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
1900043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
APPL MLTLAYR COMPRS LEG BELOW KNEE W/ANK
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
20300089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
APPL MLTLAYR COMPRS LEG BELOW KNEE W/ANK
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
1900043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$608.95 |
| 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 |
$384.60
|
| 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 |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| 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 |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| 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 |
$608.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| 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 |
$596.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
APPL MLTLAYR COMPRS LEG BELOW KNEE W/ANK
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
20300089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.89 |
| 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 |
$153.60
|
| 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 |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| 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 |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| 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 |
$243.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| 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 |
$238.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
APPL MLTLAYR COMPRS LEG BELOW KNEE W/ANK
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
8229581
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$69.89 |
| 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 |
$153.60
|
| 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 |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| 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 |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| 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 |
$243.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| 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 |
$238.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
APPL MLTLAYR COMPRS LEG BELOW KNEE W/ANK
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
8229581
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
APPL ON-BODY INJECTOR FOR TIMED SUBQ INJ
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
24500016
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$48.00
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$51.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
APPL ON-BODY INJECTOR FOR TIMED SUBQ INJ
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
24700016
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$48.00
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$51.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
APPL ON-BODY INJECTOR FOR TIMED SUBQ INJ
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
24700016
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$42.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
APPL ON-BODY INJECTOR FOR TIMED SUBQ INJ
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
24500016
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$42.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
6120690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.15 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$734.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$1,040.40
|
| Rate for Payer: First Health Commercial |
$1,101.60
|
| Rate for Payer: First Health Workers Compensation |
$472.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,101.60
|
| Rate for Payer: GEHA Commercial |
$979.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,101.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,113.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$856.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,101.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$918.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,138.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$489.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$334.15
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
|
IP
|
$2,296.00
|
|
|
Service Code
|
CPT 20692
|
| Hospital Charge Code |
6120692
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$2,181.20 |
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$1,951.60
|
| Rate for Payer: First Health Commercial |
$2,066.40
|
| Rate for Payer: First Health Workers Compensation |
$886.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,066.40
|
| Rate for Payer: GEHA Commercial |
$1,607.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,066.40
|
| Rate for Payer: Multiplan All |
$2,089.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,066.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,181.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,135.28
|
| Rate for Payer: Zelis Auto |
$918.40
|
| Rate for Payer: Zelis Worker's Compensation |
$626.81
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
6120690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.15 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$1,040.40
|
| Rate for Payer: First Health Commercial |
$1,101.60
|
| Rate for Payer: First Health Workers Compensation |
$472.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,101.60
|
| Rate for Payer: GEHA Commercial |
$856.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,101.60
|
| Rate for Payer: Multiplan All |
$1,113.84
|
| Rate for Payer: OMNI Networks Commercial |
$856.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,101.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,162.80
|
| Rate for Payer: Three Rivers Provider Network All |
$918.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,138.32
|
| Rate for Payer: Zelis Auto |
$489.60
|
| Rate for Payer: Zelis Worker's Compensation |
$334.15
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
|
OP
|
$2,296.00
|
|
|
Service Code
|
CPT 20692
|
| Hospital Charge Code |
6120692
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,377.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$1,951.60
|
| Rate for Payer: First Health Commercial |
$2,066.40
|
| Rate for Payer: First Health Workers Compensation |
$886.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,066.40
|
| Rate for Payer: GEHA Commercial |
$1,836.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,066.40
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,089.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,066.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,181.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,135.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$918.40
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$626.81
|
|
|
APPLY LONG LEG CAST BRACE
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
8229358
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$131.59 |
| 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 |
$289.20
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| 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 |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| 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 |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| 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 |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
APPLY LONG LEG CAST BRACE
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
8229358
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
APPLY REM FIXATION DEVICE
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 20660
|
| Hospital Charge Code |
6120660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,069.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,069.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$847.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$555.90
|
| Rate for Payer: First Health Commercial |
$588.60
|
| Rate for Payer: First Health Workers Compensation |
$252.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$588.60
|
| Rate for Payer: GEHA Commercial |
$523.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$588.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$864.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$595.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$457.80
|
| Rate for Payer: One Health Plan PPO/POS |
$588.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$998.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$864.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$621.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$490.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$864.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$608.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$261.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$178.54
|
|
