|
REPAIR HAND JOINT
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
6126540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.26 |
| Max. Negotiated Rate |
$1,229.30 |
| Rate for Payer: Cash Price |
$776.40
|
| Rate for Payer: Cigna Commercial |
$1,099.90
|
| Rate for Payer: First Health Commercial |
$1,164.60
|
| Rate for Payer: First Health Workers Compensation |
$499.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,164.60
|
| Rate for Payer: GEHA Commercial |
$905.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,164.60
|
| Rate for Payer: Multiplan All |
$1,177.54
|
| Rate for Payer: OMNI Networks Commercial |
$905.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,164.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,229.30
|
| Rate for Payer: Three Rivers Provider Network All |
$970.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,203.42
|
| Rate for Payer: Zelis Auto |
$517.60
|
| Rate for Payer: Zelis Worker's Compensation |
$353.26
|
|
|
REPAIR HAND JOINT
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
6126540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.26 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$776.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$776.40
|
| Rate for Payer: Cash Price |
$776.40
|
| Rate for Payer: Cigna Commercial |
$1,099.90
|
| Rate for Payer: First Health Commercial |
$1,164.60
|
| Rate for Payer: First Health Workers Compensation |
$499.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,164.60
|
| Rate for Payer: GEHA Commercial |
$1,035.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,164.60
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,177.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$905.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,164.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,229.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$970.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,203.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$517.60
|
| 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 |
$353.26
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT 26541
|
| Hospital Charge Code |
6126541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.52 |
| Max. Negotiated Rate |
$1,508.60 |
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cigna Commercial |
$1,349.80
|
| Rate for Payer: First Health Commercial |
$1,429.20
|
| Rate for Payer: First Health Workers Compensation |
$613.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,429.20
|
| Rate for Payer: GEHA Commercial |
$1,111.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,429.20
|
| Rate for Payer: Multiplan All |
$1,445.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,111.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,429.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,508.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,476.84
|
| Rate for Payer: Zelis Auto |
$635.20
|
| Rate for Payer: Zelis Worker's Compensation |
$433.52
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT 26541
|
| Hospital Charge Code |
6126541
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.52 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$952.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cigna Commercial |
$1,349.80
|
| Rate for Payer: First Health Commercial |
$1,429.20
|
| Rate for Payer: First Health Workers Compensation |
$613.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,429.20
|
| Rate for Payer: GEHA Commercial |
$1,270.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,429.20
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,445.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,111.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,429.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,508.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,476.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$635.20
|
| 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 |
$433.52
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
CPT 26542
|
| Hospital Charge Code |
6126542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$801.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$1,068.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$534.40
|
| 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 |
$364.73
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
CPT 26542
|
| Hospital Charge Code |
6126542
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$1,269.20 |
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
REPAIR HAND TENDON
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
6126410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.21 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$664.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$940.95
|
| Rate for Payer: First Health Commercial |
$996.30
|
| Rate for Payer: First Health Workers Compensation |
$427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$996.30
|
| Rate for Payer: GEHA Commercial |
$885.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$996.30
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,007.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$774.90
|
| Rate for Payer: One Health Plan PPO/POS |
$996.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,051.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$830.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,029.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$442.80
|
| 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 |
$302.21
|
|
|
REPAIR HAND TENDON
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
6126410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.21 |
| Max. Negotiated Rate |
$1,051.65 |
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$940.95
|
| Rate for Payer: First Health Commercial |
$996.30
|
| Rate for Payer: First Health Workers Compensation |
$427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$996.30
|
| Rate for Payer: GEHA Commercial |
$774.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$996.30
|
| Rate for Payer: Multiplan All |
$1,007.37
|
| Rate for Payer: OMNI Networks Commercial |
$774.90
|
| Rate for Payer: One Health Plan PPO/POS |
$996.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,051.65
|
| Rate for Payer: Three Rivers Provider Network All |
$830.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,029.51
|
| Rate for Payer: Zelis Auto |
$442.80
|
| Rate for Payer: Zelis Worker's Compensation |
$302.21
|
|
|
REPAIR HUMERUS WITH GRAFT
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT 24435
|
| Hospital Charge Code |
6124435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.33 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,326.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$1,878.50
|
| Rate for Payer: First Health Commercial |
$1,989.00
|
| Rate for Payer: First Health Workers Compensation |
$853.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,989.00
|
| Rate for Payer: GEHA Commercial |
$1,768.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,989.00
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,011.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,547.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,989.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,099.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,657.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,055.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$884.00
|
| 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 |
$603.33
|
|
|
REPAIR HUMERUS WITH GRAFT
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT 24435
|
| Hospital Charge Code |
6124435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.33 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$1,878.50
|
| Rate for Payer: First Health Commercial |
$1,989.00
|
| Rate for Payer: First Health Workers Compensation |
$853.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,989.00
|
| Rate for Payer: GEHA Commercial |
$1,547.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,989.00
|
| Rate for Payer: Multiplan All |
$2,011.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,547.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,989.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,099.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,657.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,055.30
|
| Rate for Payer: Zelis Auto |
$884.00
|
| Rate for Payer: Zelis Worker's Compensation |
$603.33
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$3,890.28
|
|
|
Service Code
|
CPT 54163
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,653.37 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: First Health Workers Compensation |
$2,503.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,770.08
|
|
|
REPAIR ING HERNIA, SLIDING
|
Facility
|
IP
|
$1,743.39
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
6149525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.95 |
| Max. Negotiated Rate |
$1,656.22 |
| Rate for Payer: Cash Price |
$1,046.03
|
| Rate for Payer: Cigna Commercial |
$1,481.88
|
| Rate for Payer: First Health Commercial |
$1,569.05
|
| Rate for Payer: First Health Workers Compensation |
$673.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,569.05
|
| Rate for Payer: GEHA Commercial |
$1,220.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,569.05
|
| Rate for Payer: Multiplan All |
$1,586.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,220.37
|
| Rate for Payer: One Health Plan PPO/POS |
$1,569.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,656.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,307.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,621.35
|
| Rate for Payer: Zelis Auto |
$697.36
|
| Rate for Payer: Zelis Worker's Compensation |
$475.95
|
|
|
REPAIR ING HERNIA, SLIDING
|
Facility
|
OP
|
$1,743.39
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
6149525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.95 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,046.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$1,046.03
|
| Rate for Payer: Cash Price |
$1,046.03
|
| Rate for Payer: Cigna Commercial |
$1,481.88
|
| Rate for Payer: First Health Commercial |
$1,569.05
|
| Rate for Payer: First Health Workers Compensation |
$673.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,569.05
|
| Rate for Payer: GEHA Commercial |
$1,394.71
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,569.05
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,586.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,220.37
|
| Rate for Payer: One Health Plan PPO/POS |
$1,569.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,656.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,307.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,621.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$697.36
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$475.95
|
|
|
REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
|
Facility
|
OP
|
$6,701.96
|
|
|
Service Code
|
CPT 49525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,560.61 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE
|
Facility
|
OP
|
$6,701.96
|
|
|
Service Code
|
CPT 49505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,560.61 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 12.6-20CM
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
21600178
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$214.31 |
| Max. Negotiated Rate |
$745.75 |
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$667.25
|
| Rate for Payer: First Health Commercial |
$706.50
|
| Rate for Payer: First Health Workers Compensation |
$303.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$706.50
|
| Rate for Payer: GEHA Commercial |
$549.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$706.50
|
| Rate for Payer: Multiplan All |
$714.35
|
| Rate for Payer: OMNI Networks Commercial |
$549.50
|
| Rate for Payer: One Health Plan PPO/POS |
$706.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$745.75
|
| Rate for Payer: Three Rivers Provider Network All |
$588.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.05
|
| Rate for Payer: Zelis Auto |
$314.00
|
| Rate for Payer: Zelis Worker's Compensation |
$214.31
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 12.6-20CM
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
21600178
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$214.31 |
| 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 |
$471.00
|
| 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 |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$667.25
|
| Rate for Payer: First Health Commercial |
$706.50
|
| Rate for Payer: First Health Workers Compensation |
$303.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$706.50
|
| Rate for Payer: GEHA Commercial |
$628.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$706.50
|
| 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 |
$714.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$549.50
|
| Rate for Payer: One Health Plan PPO/POS |
$706.50
|
| 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 |
$745.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$588.75
|
| 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 |
$730.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$314.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$214.31
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 12.6-20CM
|
Facility
|
OP
|
$1,368.00
|
|
| Hospital Charge Code |
8150022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna Commercial |
$1,162.80
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: First Health Workers Compensation |
$528.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,231.20
|
| Rate for Payer: GEHA Commercial |
$1,094.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,231.20
|
| Rate for Payer: Humana ChoiceCare |
$355.68
|
| Rate for Payer: Multiplan All |
$1,244.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$820.80
|
| Rate for Payer: OMNI Networks Commercial |
$957.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,231.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,299.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,203.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,272.24
|
| Rate for Payer: Zelis Auto |
$547.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$684.00
|
| Rate for Payer: Zelis Worker's Compensation |
$373.46
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 12.6-20CM
|
Facility
|
IP
|
$1,368.00
|
|
| Hospital Charge Code |
8150022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.46 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna Commercial |
$1,162.80
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: First Health Workers Compensation |
$528.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,231.20
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,231.20
|
| Rate for Payer: Multiplan All |
$1,244.88
|
| Rate for Payer: OMNI Networks Commercial |
$957.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,231.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,299.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,272.24
|
| Rate for Payer: Zelis Auto |
$547.20
|
| Rate for Payer: Zelis Worker's Compensation |
$373.46
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 12.6-20CM
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
6112055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.31 |
| Max. Negotiated Rate |
$745.75 |
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$667.25
|
| Rate for Payer: First Health Commercial |
$706.50
|
| Rate for Payer: First Health Workers Compensation |
$303.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$706.50
|
| Rate for Payer: GEHA Commercial |
$549.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$706.50
|
| Rate for Payer: Multiplan All |
$714.35
|
| Rate for Payer: OMNI Networks Commercial |
$549.50
|
| Rate for Payer: One Health Plan PPO/POS |
$706.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$745.75
|
| Rate for Payer: Three Rivers Provider Network All |
$588.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.05
|
| Rate for Payer: Zelis Auto |
$314.00
|
| Rate for Payer: Zelis Worker's Compensation |
$214.31
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 12.6-20CM
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
6112055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.31 |
| 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 |
$471.00
|
| 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 |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$667.25
|
| Rate for Payer: First Health Commercial |
$706.50
|
| Rate for Payer: First Health Workers Compensation |
$303.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$706.50
|
| Rate for Payer: GEHA Commercial |
$628.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$706.50
|
| 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 |
$714.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$549.50
|
| Rate for Payer: One Health Plan PPO/POS |
$706.50
|
| 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 |
$745.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$588.75
|
| 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 |
$730.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$314.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$214.31
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
6112051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| 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 |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
IP
|
$803.04
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
20312051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$762.89 |
| Rate for Payer: Cash Price |
$481.82
|
| Rate for Payer: Cigna Commercial |
$682.58
|
| Rate for Payer: First Health Commercial |
$722.74
|
| Rate for Payer: First Health Workers Compensation |
$310.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.74
|
| Rate for Payer: GEHA Commercial |
$562.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.74
|
| Rate for Payer: Multiplan All |
$730.77
|
| Rate for Payer: OMNI Networks Commercial |
$562.13
|
| Rate for Payer: One Health Plan PPO/POS |
$722.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$762.89
|
| Rate for Payer: Three Rivers Provider Network All |
$602.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$746.83
|
| Rate for Payer: Zelis Auto |
$321.22
|
| Rate for Payer: Zelis Worker's Compensation |
$219.23
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
21600098
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| 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 |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
OP
|
$1,108.00
|
|
| Hospital Charge Code |
8150018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$1,052.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$941.80
|
| Rate for Payer: First Health Commercial |
$997.20
|
| Rate for Payer: First Health Workers Compensation |
$427.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$997.20
|
| Rate for Payer: GEHA Commercial |
$886.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$997.20
|
| Rate for Payer: Humana ChoiceCare |
$288.08
|
| Rate for Payer: Multiplan All |
$1,008.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$664.80
|
| Rate for Payer: OMNI Networks Commercial |
$775.60
|
| Rate for Payer: One Health Plan PPO/POS |
$997.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,052.60
|
| Rate for Payer: Three Rivers Provider Network All |
$831.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$975.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$277.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,030.44
|
| Rate for Payer: Zelis Auto |
$443.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$554.00
|
| Rate for Payer: Zelis Worker's Compensation |
$302.48
|
|
