|
REPAIR COMP F/C/C/M/N/AX/G/H/F 1.1-2.5CM
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
21600186
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 1.1-2.5CM
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
6113131
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 1.1-2.5CM
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
8150026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$1,300.50
|
| Rate for Payer: First Health Commercial |
$1,377.00
|
| Rate for Payer: First Health Workers Compensation |
$590.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.00
|
| Rate for Payer: GEHA Commercial |
$1,071.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.00
|
| Rate for Payer: Multiplan All |
$1,392.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,453.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,147.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,422.90
|
| Rate for Payer: Zelis Auto |
$612.00
|
| Rate for Payer: Zelis Worker's Compensation |
$417.69
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 1.1-2.5CM
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
21600186
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| 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 |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| 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 |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| 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 |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 1.1-2.5CM
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
6113131
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| 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 |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| 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 |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| 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 |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 2.6-7.5CM
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
6113132
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$221.13 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$688.50
|
| Rate for Payer: First Health Commercial |
$729.00
|
| Rate for Payer: First Health Workers Compensation |
$312.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$729.00
|
| Rate for Payer: GEHA Commercial |
$567.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$729.00
|
| Rate for Payer: Multiplan All |
$737.10
|
| Rate for Payer: OMNI Networks Commercial |
$567.00
|
| Rate for Payer: One Health Plan PPO/POS |
$729.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$769.50
|
| Rate for Payer: Three Rivers Provider Network All |
$607.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$753.30
|
| Rate for Payer: Zelis Auto |
$324.00
|
| Rate for Payer: Zelis Worker's Compensation |
$221.13
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 2.6-7.5CM
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
6113132
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$221.13 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$688.50
|
| Rate for Payer: First Health Commercial |
$729.00
|
| Rate for Payer: First Health Workers Compensation |
$312.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$729.00
|
| Rate for Payer: GEHA Commercial |
$648.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$729.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$737.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$567.00
|
| Rate for Payer: One Health Plan PPO/POS |
$729.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$769.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$607.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$753.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$324.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$221.13
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 2.6-7.5CM
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
21600187
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$221.13 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$688.50
|
| Rate for Payer: First Health Commercial |
$729.00
|
| Rate for Payer: First Health Workers Compensation |
$312.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$729.00
|
| Rate for Payer: GEHA Commercial |
$648.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$729.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$737.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$567.00
|
| Rate for Payer: One Health Plan PPO/POS |
$729.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$769.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$607.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$753.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$324.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$221.13
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 2.6-7.5CM
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
21600187
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$221.13 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$688.50
|
| Rate for Payer: First Health Commercial |
$729.00
|
| Rate for Payer: First Health Workers Compensation |
$312.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$729.00
|
| Rate for Payer: GEHA Commercial |
$567.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$729.00
|
| Rate for Payer: Multiplan All |
$737.10
|
| Rate for Payer: OMNI Networks Commercial |
$567.00
|
| Rate for Payer: One Health Plan PPO/POS |
$729.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$769.50
|
| Rate for Payer: Three Rivers Provider Network All |
$607.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$753.30
|
| Rate for Payer: Zelis Auto |
$324.00
|
| Rate for Payer: Zelis Worker's Compensation |
$221.13
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 2.6-7.5CM
|
Facility
|
OP
|
$2,307.00
|
|
| Hospital Charge Code |
8150027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.75 |
| Max. Negotiated Rate |
$2,191.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,384.20
|
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Cigna Commercial |
$1,960.95
|
| Rate for Payer: First Health Commercial |
$2,076.30
|
| Rate for Payer: First Health Workers Compensation |
$890.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,076.30
|
| Rate for Payer: GEHA Commercial |
$1,845.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,076.30
|
| Rate for Payer: Humana ChoiceCare |
$599.82
|
| Rate for Payer: Multiplan All |
$2,099.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,384.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,614.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,076.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,191.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,730.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,030.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$576.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,145.51
|
| Rate for Payer: Zelis Auto |
$922.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,153.50
|
| Rate for Payer: Zelis Worker's Compensation |
$629.81
|
|
|
REPAIR COMP F/C/C/M/N/AX/G/H/F 2.6-7.5CM
|
Facility
|
IP
|
$2,307.00
|
|
| Hospital Charge Code |
8150027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$629.81 |
| Max. Negotiated Rate |
$2,191.65 |
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Cigna Commercial |
$1,960.95
|
| Rate for Payer: First Health Commercial |
$2,076.30
|
| Rate for Payer: First Health Workers Compensation |
$890.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,076.30
|
| Rate for Payer: GEHA Commercial |
$1,614.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,076.30
|
| Rate for Payer: Multiplan All |
$2,099.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,614.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,076.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,191.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,730.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,145.51
|
| Rate for Payer: Zelis Auto |
$922.80
|
| Rate for Payer: Zelis Worker's Compensation |
$629.81
|
|
|
REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
21600185
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: First Health Workers Compensation |
$265.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$480.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Worker's Compensation |
$187.55
|
|
|
REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
21600185
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$412.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: First Health Workers Compensation |
$265.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$549.60
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$187.55
|
|
|
REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$1,575.00
|
|
| Hospital Charge Code |
8150024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$429.98 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,102.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
6113121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$412.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: First Health Workers Compensation |
$265.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$549.60
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$187.55
|
|
|
REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
6113121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: First Health Workers Compensation |
$265.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$480.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Worker's Compensation |
$187.55
|
|
|
REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$1,575.00
|
|
| Hospital Charge Code |
8150024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Humana ChoiceCare |
$409.50
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$945.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,386.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$787.50
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
REPAIR DEFORMITY OF TOE
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
6128313
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$777.75
|
| Rate for Payer: First Health Commercial |
$823.50
|
| Rate for Payer: First Health Workers Compensation |
$353.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$823.50
|
| Rate for Payer: GEHA Commercial |
$640.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$823.50
|
| Rate for Payer: Multiplan All |
$832.65
|
| Rate for Payer: OMNI Networks Commercial |
$640.50
|
| Rate for Payer: One Health Plan PPO/POS |
$823.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$869.25
|
| Rate for Payer: Three Rivers Provider Network All |
$686.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.95
|
| Rate for Payer: Zelis Auto |
$366.00
|
| Rate for Payer: Zelis Worker's Compensation |
$249.79
|
|
|
REPAIR DEFORMITY OF TOE
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
6128313
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$777.75
|
| Rate for Payer: First Health Commercial |
$823.50
|
| Rate for Payer: First Health Workers Compensation |
$353.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$823.50
|
| Rate for Payer: GEHA Commercial |
$732.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$823.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$832.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$640.50
|
| Rate for Payer: One Health Plan PPO/POS |
$823.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$869.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$686.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$366.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$249.79
|
|
|
REPAIR DEGENERATED KNEECAP
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
CPT 27418
|
| Hospital Charge Code |
6127418
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,445.00
|
| Rate for Payer: First Health Commercial |
$1,530.00
|
| Rate for Payer: First Health Workers Compensation |
$656.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.00
|
| Rate for Payer: GEHA Commercial |
$1,360.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,547.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$680.00
|
| 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 |
$464.10
|
|
|
REPAIR DEGENERATED KNEECAP
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
CPT 27418
|
| Hospital Charge Code |
6127418
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$1,615.00 |
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,445.00
|
| Rate for Payer: First Health Commercial |
$1,530.00
|
| Rate for Payer: First Health Workers Compensation |
$656.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.00
|
| Rate for Payer: GEHA Commercial |
$1,190.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.00
|
| Rate for Payer: Multiplan All |
$1,547.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.00
|
| Rate for Payer: Zelis Auto |
$680.00
|
| Rate for Payer: Zelis Worker's Compensation |
$464.10
|
|
|
REPAIR DIAPHRAGM LACERATION
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
CPT 39501
|
| Hospital Charge Code |
6139501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$485.94 |
| Max. Negotiated Rate |
$1,691.00 |
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,513.00
|
| Rate for Payer: First Health Commercial |
$1,602.00
|
| Rate for Payer: First Health Workers Compensation |
$687.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,602.00
|
| Rate for Payer: GEHA Commercial |
$1,246.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,602.00
|
| Rate for Payer: Multiplan All |
$1,619.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,246.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,602.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,691.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,335.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,655.40
|
| Rate for Payer: Zelis Auto |
$712.00
|
| Rate for Payer: Zelis Worker's Compensation |
$485.94
|
|
|
REPAIR DIAPHRAGM LACERATION
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
CPT 39501
|
| Hospital Charge Code |
6139501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.00 |
| Max. Negotiated Rate |
$1,691.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,513.00
|
| Rate for Payer: First Health Commercial |
$1,602.00
|
| Rate for Payer: First Health Workers Compensation |
$687.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,602.00
|
| Rate for Payer: GEHA Commercial |
$1,424.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,602.00
|
| Rate for Payer: Humana ChoiceCare |
$462.80
|
| Rate for Payer: Multiplan All |
$1,619.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,068.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,246.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,602.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,691.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,335.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,566.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$445.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,655.40
|
| Rate for Payer: Zelis Auto |
$712.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$890.00
|
| Rate for Payer: Zelis Worker's Compensation |
$485.94
|
|
|
REPAIR DISLOCATED JAW
|
Facility
|
IP
|
$1,886.00
|
|
|
Service Code
|
CPT 21490
|
| Hospital Charge Code |
6121490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.88 |
| Max. Negotiated Rate |
$1,791.70 |
| Rate for Payer: Cash Price |
$1,131.60
|
| Rate for Payer: Cigna Commercial |
$1,603.10
|
| Rate for Payer: First Health Commercial |
$1,697.40
|
| Rate for Payer: First Health Workers Compensation |
$728.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,697.40
|
| Rate for Payer: GEHA Commercial |
$1,320.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,697.40
|
| Rate for Payer: Multiplan All |
$1,716.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,320.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,697.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,791.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,414.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,753.98
|
| Rate for Payer: Zelis Auto |
$754.40
|
| Rate for Payer: Zelis Worker's Compensation |
$514.88
|
|
|
REPAIR DISLOCATED JAW
|
Facility
|
OP
|
$1,886.00
|
|
|
Service Code
|
CPT 21490
|
| Hospital Charge Code |
6121490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.88 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,131.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$1,131.60
|
| Rate for Payer: Cash Price |
$1,131.60
|
| Rate for Payer: Cigna Commercial |
$1,603.10
|
| Rate for Payer: First Health Commercial |
$1,697.40
|
| Rate for Payer: First Health Workers Compensation |
$728.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,697.40
|
| Rate for Payer: GEHA Commercial |
$1,508.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,697.40
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,716.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,320.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,697.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,791.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,414.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,753.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$754.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$514.88
|
|
