|
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
|
$718.23
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
7212041
|
|
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 |
$430.94
|
| 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 |
$430.94
|
| 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 |
$574.58
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$646.41
|
| 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 |
$653.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$502.76
|
| Rate for Payer: One Health Plan PPO/POS |
$646.41
|
| 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 |
$682.32
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$538.67
|
| 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 |
$667.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$287.29
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$196.08
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5
|
Facility
|
IP
|
$718.23
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
8512041
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$2,045.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
1912031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.28 |
| Max. Negotiated Rate |
$1,942.75 |
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$1,738.25
|
| Rate for Payer: First Health Commercial |
$1,840.50
|
| Rate for Payer: First Health Workers Compensation |
$789.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,840.50
|
| Rate for Payer: GEHA Commercial |
$1,431.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,840.50
|
| Rate for Payer: Multiplan All |
$1,860.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,431.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,840.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,942.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,533.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,901.85
|
| Rate for Payer: Zelis Auto |
$818.00
|
| Rate for Payer: Zelis Worker's Compensation |
$558.28
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
8150010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: First Health Workers Compensation |
$405.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$840.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Humana ChoiceCare |
$273.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$630.00
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$924.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$525.00
|
| Rate for Payer: Zelis Worker's Compensation |
$286.65
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$2,045.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
1912031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$1,942.75 |
| 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 |
$1,227.00
|
| 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 |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$1,738.25
|
| Rate for Payer: First Health Commercial |
$1,840.50
|
| Rate for Payer: First Health Workers Compensation |
$789.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,840.50
|
| Rate for Payer: GEHA Commercial |
$1,636.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,840.50
|
| 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 |
$1,860.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,431.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,840.50
|
| 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 |
$1,942.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,533.75
|
| 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 |
$1,901.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$818.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$558.28
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
20312031
|
|
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 |
$279.60
|
| 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 |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| 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 |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| 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 |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| 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 |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$713.04
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
8512031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.66 |
| Max. Negotiated Rate |
$677.39 |
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cigna Commercial |
$606.08
|
| Rate for Payer: First Health Commercial |
$641.74
|
| Rate for Payer: First Health Workers Compensation |
$275.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$641.74
|
| Rate for Payer: GEHA Commercial |
$499.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$641.74
|
| Rate for Payer: Multiplan All |
$648.87
|
| Rate for Payer: OMNI Networks Commercial |
$499.13
|
| Rate for Payer: One Health Plan PPO/POS |
$641.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$677.39
|
| Rate for Payer: Three Rivers Provider Network All |
$534.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$663.13
|
| Rate for Payer: Zelis Auto |
$285.22
|
| Rate for Payer: Zelis Worker's Compensation |
$194.66
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
6112031
|
|
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 |
$279.60
|
| 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 |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| 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 |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| 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 |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| 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 |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$713.04
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
8512031
|
|
Hospital Revenue Code
|
521
|
| 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 |
$427.82
|
| 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 |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cigna Commercial |
$606.08
|
| Rate for Payer: First Health Commercial |
$641.74
|
| Rate for Payer: First Health Workers Compensation |
$275.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$641.74
|
| Rate for Payer: GEHA Commercial |
$570.43
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$641.74
|
| 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 |
$648.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$499.13
|
| Rate for Payer: One Health Plan PPO/POS |
$641.74
|
| 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 |
$677.39
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$534.78
|
| 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 |
$663.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$285.22
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$194.66
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
21600179
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$326.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
8150010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: First Health Workers Compensation |
$405.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$735.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
| Rate for Payer: Zelis Worker's Compensation |
$286.65
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$713.04
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
7212031
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$194.66 |
| Max. Negotiated Rate |
$677.39 |
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cigna Commercial |
$606.08
|
| Rate for Payer: First Health Commercial |
$641.74
|
| Rate for Payer: First Health Workers Compensation |
$275.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$641.74
|
| Rate for Payer: GEHA Commercial |
$499.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$641.74
|
| Rate for Payer: Multiplan All |
$648.87
|
| Rate for Payer: OMNI Networks Commercial |
$499.13
|
| Rate for Payer: One Health Plan PPO/POS |
$641.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$677.39
|
| Rate for Payer: Three Rivers Provider Network All |
$534.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$663.13
|
| Rate for Payer: Zelis Auto |
$285.22
|
| Rate for Payer: Zelis Worker's Compensation |
$194.66
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$713.04
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
7212031
|
|
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 |
$427.82
|
| 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 |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cigna Commercial |
$606.08
|
| Rate for Payer: First Health Commercial |
$641.74
|
| Rate for Payer: First Health Workers Compensation |
$275.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$641.74
|
| Rate for Payer: GEHA Commercial |
$570.43
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$641.74
|
| 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 |
$648.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$499.13
|
| Rate for Payer: One Health Plan PPO/POS |
$641.74
|
| 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 |
$677.39
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$534.78
|
| 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 |
$663.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$285.22
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$194.66
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
6112031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$326.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
21600179
|
|
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 |
$279.60
|
| 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 |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| 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 |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| 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 |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| 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 |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
20312031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$326.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$830.85
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
7212032
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$226.82 |
| Max. Negotiated Rate |
$789.31 |
| 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 |
$498.51
|
| 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 |
$498.51
|
| Rate for Payer: Cash Price |
$498.51
|
| Rate for Payer: Cigna Commercial |
$706.22
|
| Rate for Payer: First Health Commercial |
$747.76
|
| Rate for Payer: First Health Workers Compensation |
$320.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.76
|
| Rate for Payer: GEHA Commercial |
$664.68
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.76
|
| 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 |
$756.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$581.60
|
| Rate for Payer: One Health Plan PPO/POS |
$747.76
|
| 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 |
$789.31
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$623.14
|
| 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 |
$772.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$332.34
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$226.82
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
21600180
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$162.16 |
| 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 |
$356.40
|
| 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$475.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| 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 |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| 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 |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| 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 |
$552.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$830.85
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
7212032
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$226.82 |
| Max. Negotiated Rate |
$789.31 |
| Rate for Payer: Cash Price |
$498.51
|
| Rate for Payer: Cigna Commercial |
$706.22
|
| Rate for Payer: First Health Commercial |
$747.76
|
| Rate for Payer: First Health Workers Compensation |
$320.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.76
|
| Rate for Payer: GEHA Commercial |
$581.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.76
|
| Rate for Payer: Multiplan All |
$756.07
|
| Rate for Payer: OMNI Networks Commercial |
$581.60
|
| Rate for Payer: One Health Plan PPO/POS |
$747.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$789.31
|
| Rate for Payer: Three Rivers Provider Network All |
$623.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$772.69
|
| Rate for Payer: Zelis Auto |
$332.34
|
| Rate for Payer: Zelis Worker's Compensation |
$226.82
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
6112032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.16 |
| 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 |
$356.40
|
| 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$475.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| 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 |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| 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 |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| 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 |
$552.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
8512302
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$162.16 |
| 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 |
$356.40
|
| 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$475.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| 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 |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| 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 |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| 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 |
$552.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
6112032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.16 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$415.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
8512302
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$162.16 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$415.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
21600180
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$162.16 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$415.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
