|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
IP
|
$1,108.00
|
|
| Hospital Charge Code |
8150018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.48 |
| Max. Negotiated Rate |
$1,052.60 |
| 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 |
$775.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$997.20
|
| Rate for Payer: Multiplan All |
$1,008.28
|
| 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: United Payors & United Providers UP&UP |
$1,030.44
|
| Rate for Payer: Zelis Auto |
$443.20
|
| Rate for Payer: Zelis Worker's Compensation |
$302.48
|
|
|
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
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
6112051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$498.75 |
| 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 |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.5CM/<
|
Facility
|
OP
|
$803.04
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
20312051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$762.89 |
| 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 |
$481.82
|
| 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 |
$481.82
|
| 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 |
$642.43
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.74
|
| 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 |
$730.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$562.13
|
| Rate for Payer: One Health Plan PPO/POS |
$722.74
|
| 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 |
$762.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$602.28
|
| 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 |
$746.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$321.22
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$219.23
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.6-5.0CM
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
6112052
|
|
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 |
$312.60
|
| 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 |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$442.85
|
| Rate for Payer: First Health Commercial |
$468.90
|
| Rate for Payer: First Health Workers Compensation |
$201.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.90
|
| Rate for Payer: GEHA Commercial |
$416.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.90
|
| 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 |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$474.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$364.70
|
| Rate for Payer: One Health Plan PPO/POS |
$468.90
|
| 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 |
$494.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$390.75
|
| 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 |
$484.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$208.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$142.23
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.6-5.0CM
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
8150019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.39 |
| Max. Negotiated Rate |
$1,048.80 |
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: First Health Commercial |
$993.60
|
| Rate for Payer: First Health Workers Compensation |
$426.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$993.60
|
| Rate for Payer: GEHA Commercial |
$772.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$993.60
|
| Rate for Payer: Multiplan All |
$1,004.64
|
| Rate for Payer: OMNI Networks Commercial |
$772.80
|
| Rate for Payer: One Health Plan PPO/POS |
$993.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,048.80
|
| Rate for Payer: Three Rivers Provider Network All |
$828.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,026.72
|
| Rate for Payer: Zelis Auto |
$441.60
|
| Rate for Payer: Zelis Worker's Compensation |
$301.39
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.6-5.0CM
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
21600175
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$142.23 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$442.85
|
| Rate for Payer: First Health Commercial |
$468.90
|
| Rate for Payer: First Health Workers Compensation |
$201.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.90
|
| Rate for Payer: GEHA Commercial |
$364.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.90
|
| Rate for Payer: Multiplan All |
$474.11
|
| Rate for Payer: OMNI Networks Commercial |
$364.70
|
| Rate for Payer: One Health Plan PPO/POS |
$468.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.95
|
| Rate for Payer: Three Rivers Provider Network All |
$390.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$484.53
|
| Rate for Payer: Zelis Auto |
$208.40
|
| Rate for Payer: Zelis Worker's Compensation |
$142.23
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.6-5.0CM
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
8150019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$1,048.80 |
| 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 |
$662.40
|
| 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 |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: First Health Commercial |
$993.60
|
| Rate for Payer: First Health Workers Compensation |
$426.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$993.60
|
| Rate for Payer: GEHA Commercial |
$883.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$993.60
|
| 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 |
$1,004.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$772.80
|
| Rate for Payer: One Health Plan PPO/POS |
$993.60
|
| 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 |
$1,048.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$828.00
|
| 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 |
$1,026.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$441.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$301.39
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.6-5.0CM
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
6112052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.23 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$442.85
|
| Rate for Payer: First Health Commercial |
$468.90
|
| Rate for Payer: First Health Workers Compensation |
$201.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.90
|
| Rate for Payer: GEHA Commercial |
$364.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.90
|
| Rate for Payer: Multiplan All |
$474.11
|
| Rate for Payer: OMNI Networks Commercial |
$364.70
|
| Rate for Payer: One Health Plan PPO/POS |
$468.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.95
|
| Rate for Payer: Three Rivers Provider Network All |
$390.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$484.53
|
| Rate for Payer: Zelis Auto |
$208.40
|
| Rate for Payer: Zelis Worker's Compensation |
$142.23
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 2.6-5.0CM
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
21600175
|
|
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 |
$312.60
|
| 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 |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$442.85
|
| Rate for Payer: First Health Commercial |
$468.90
|
| Rate for Payer: First Health Workers Compensation |
$201.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.90
|
| Rate for Payer: GEHA Commercial |
$416.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.90
|
| 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 |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$474.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$364.70
|
| Rate for Payer: One Health Plan PPO/POS |
$468.90
|
| 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 |
$494.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$390.75
|
| 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 |
$484.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$208.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$142.23
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 5.1-7.5CM
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
21600176
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$152.06 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$473.45
|
| Rate for Payer: First Health Commercial |
$501.30
|
| Rate for Payer: First Health Workers Compensation |
$215.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$501.30
|
| Rate for Payer: GEHA Commercial |
$389.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$501.30
|
| Rate for Payer: Multiplan All |
$506.87
|
| Rate for Payer: OMNI Networks Commercial |
$389.90
|
| Rate for Payer: One Health Plan PPO/POS |
$501.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$529.15
|
| Rate for Payer: Three Rivers Provider Network All |
$417.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.01
|
| Rate for Payer: Zelis Auto |
$222.80
|
| Rate for Payer: Zelis Worker's Compensation |
$152.06
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 5.1-7.5CM
|
Facility
|
IP
|
$1,141.00
|
|
| Hospital Charge Code |
8150020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$1,083.95 |
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cigna Commercial |
$969.85
|
| Rate for Payer: First Health Commercial |
$1,026.90
|
| Rate for Payer: First Health Workers Compensation |
$440.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.90
|
| Rate for Payer: GEHA Commercial |
$798.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.90
|
| Rate for Payer: Multiplan All |
$1,038.31
|
| Rate for Payer: OMNI Networks Commercial |
$798.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.95
|
| Rate for Payer: Three Rivers Provider Network All |
$855.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,061.13
|
| Rate for Payer: Zelis Auto |
$456.40
|
| Rate for Payer: Zelis Worker's Compensation |
$311.49
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 5.1-7.5CM
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
6112053
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.06 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$473.45
|
| Rate for Payer: First Health Commercial |
$501.30
|
| Rate for Payer: First Health Workers Compensation |
$215.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$501.30
|
| Rate for Payer: GEHA Commercial |
$389.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$501.30
|
| Rate for Payer: Multiplan All |
$506.87
|
| Rate for Payer: OMNI Networks Commercial |
$389.90
|
| Rate for Payer: One Health Plan PPO/POS |
$501.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$529.15
|
| Rate for Payer: Three Rivers Provider Network All |
$417.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.01
|
| Rate for Payer: Zelis Auto |
$222.80
|
| Rate for Payer: Zelis Worker's Compensation |
$152.06
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 5.1-7.5CM
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
6112053
|
|
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 |
$334.20
|
| 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 |
$334.20
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$473.45
|
| Rate for Payer: First Health Commercial |
$501.30
|
| Rate for Payer: First Health Workers Compensation |
$215.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$501.30
|
| Rate for Payer: GEHA Commercial |
$445.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$501.30
|
| 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 |
$506.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$389.90
|
| Rate for Payer: One Health Plan PPO/POS |
$501.30
|
| 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 |
$529.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$417.75
|
| 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 |
$518.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$222.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$152.06
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 5.1-7.5CM
|
Facility
|
OP
|
$1,141.00
|
|
| Hospital Charge Code |
8150020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$1,083.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$684.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cigna Commercial |
$969.85
|
| Rate for Payer: First Health Commercial |
$1,026.90
|
| Rate for Payer: First Health Workers Compensation |
$440.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.90
|
| Rate for Payer: GEHA Commercial |
$912.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.90
|
| Rate for Payer: Humana ChoiceCare |
$296.66
|
| Rate for Payer: Multiplan All |
$1,038.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$684.60
|
| Rate for Payer: OMNI Networks Commercial |
$798.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.95
|
| Rate for Payer: Three Rivers Provider Network All |
$855.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,004.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$285.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,061.13
|
| Rate for Payer: Zelis Auto |
$456.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$570.50
|
| Rate for Payer: Zelis Worker's Compensation |
$311.49
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 5.1-7.5CM
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
21600176
|
|
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 |
$334.20
|
| 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 |
$334.20
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$473.45
|
| Rate for Payer: First Health Commercial |
$501.30
|
| Rate for Payer: First Health Workers Compensation |
$215.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$501.30
|
| Rate for Payer: GEHA Commercial |
$445.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$501.30
|
| 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 |
$506.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$389.90
|
| Rate for Payer: One Health Plan PPO/POS |
$501.30
|
| 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 |
$529.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$417.75
|
| 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 |
$518.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$222.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$152.06
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 7.6-12.5C
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
21600177
|
|
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 |
$343.20
|
| 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 |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| 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 |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| 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 |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| 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 |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 7.6-12.5C
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
6112054
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 7.6-12.5C
|
Facility
|
IP
|
$953.00
|
|
| Hospital Charge Code |
8150021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.17 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$667.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 7.6-12.5C
|
Facility
|
OP
|
$953.00
|
|
| Hospital Charge Code |
8150021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.25 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$762.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Humana ChoiceCare |
$247.78
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$571.80
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$838.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$238.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$476.50
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 7.6-12.5C
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
21600177
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
REPAIR INTERMED F/E/E/N/L&/MUC 7.6-12.5C
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
6112054
|
|
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 |
$343.20
|
| 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 |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| 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 |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| 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 |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| 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 |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5
|
Facility
|
IP
|
$767.34
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
20312041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.48 |
| Max. Negotiated Rate |
$728.97 |
| Rate for Payer: Cash Price |
$460.40
|
| Rate for Payer: Cigna Commercial |
$652.24
|
| Rate for Payer: First Health Commercial |
$690.61
|
| Rate for Payer: First Health Workers Compensation |
$296.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$690.61
|
| Rate for Payer: GEHA Commercial |
$537.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$690.61
|
| Rate for Payer: Multiplan All |
$698.28
|
| Rate for Payer: OMNI Networks Commercial |
$537.14
|
| Rate for Payer: One Health Plan PPO/POS |
$690.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$728.97
|
| Rate for Payer: Three Rivers Provider Network All |
$575.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$713.63
|
| Rate for Payer: Zelis Auto |
$306.94
|
| Rate for Payer: Zelis Worker's Compensation |
$209.48
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5
|
Facility
|
OP
|
$767.34
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
20312041
|
|
Hospital Revenue Code
|
510
|
| 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 |
$460.40
|
| 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 |
$460.40
|
| Rate for Payer: Cash Price |
$460.40
|
| Rate for Payer: Cigna Commercial |
$652.24
|
| Rate for Payer: First Health Commercial |
$690.61
|
| Rate for Payer: First Health Workers Compensation |
$296.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$690.61
|
| Rate for Payer: GEHA Commercial |
$613.87
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$690.61
|
| 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 |
$698.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$537.14
|
| Rate for Payer: One Health Plan PPO/POS |
$690.61
|
| 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 |
$728.97
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$575.50
|
| 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 |
$713.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$306.94
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$209.48
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5
|
Facility
|
IP
|
$718.23
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
7212041
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$196.08 |
| Max. Negotiated Rate |
$682.32 |
| Rate for Payer: Cash Price |
$430.94
|
| Rate for Payer: Cigna Commercial |
$610.50
|
| Rate for Payer: First Health Commercial |
$646.41
|
| Rate for Payer: First Health Workers Compensation |
$277.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$646.41
|
| Rate for Payer: GEHA Commercial |
$502.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$646.41
|
| Rate for Payer: Multiplan All |
$653.59
|
| Rate for Payer: OMNI Networks Commercial |
$502.76
|
| Rate for Payer: One Health Plan PPO/POS |
$646.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$682.32
|
| Rate for Payer: Three Rivers Provider Network All |
$538.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$667.95
|
| Rate for Payer: Zelis Auto |
$287.29
|
| Rate for Payer: Zelis Worker's Compensation |
$196.08
|
|
