|
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
|
|
|
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
|
$830.95
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
8512032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$226.85 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Cash Price |
$498.57
|
| Rate for Payer: Cigna Commercial |
$706.31
|
| Rate for Payer: First Health Commercial |
$747.86
|
| Rate for Payer: First Health Workers Compensation |
$320.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.86
|
| Rate for Payer: GEHA Commercial |
$581.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.86
|
| Rate for Payer: Multiplan All |
$756.16
|
| Rate for Payer: OMNI Networks Commercial |
$581.66
|
| Rate for Payer: One Health Plan PPO/POS |
$747.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$789.40
|
| Rate for Payer: Three Rivers Provider Network All |
$623.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$772.78
|
| Rate for Payer: Zelis Auto |
$332.38
|
| Rate for Payer: Zelis Worker's Compensation |
$226.85
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$830.95
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
8512032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$226.85 |
| Max. Negotiated Rate |
$789.40 |
| 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 |
$498.57
|
| 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 |
$498.57
|
| Rate for Payer: Cash Price |
$498.57
|
| Rate for Payer: Cigna Commercial |
$706.31
|
| Rate for Payer: First Health Commercial |
$747.86
|
| Rate for Payer: First Health Workers Compensation |
$320.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.86
|
| Rate for Payer: GEHA Commercial |
$664.76
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.86
|
| 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 |
$756.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$581.66
|
| Rate for Payer: One Health Plan PPO/POS |
$747.86
|
| 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 |
$789.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$623.21
|
| 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 |
$772.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$332.38
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$226.85
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$1,112.00
|
|
| Hospital Charge Code |
8150012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$1,056.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cigna Commercial |
$945.20
|
| Rate for Payer: First Health Commercial |
$1,000.80
|
| Rate for Payer: First Health Workers Compensation |
$429.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,000.80
|
| Rate for Payer: GEHA Commercial |
$889.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,000.80
|
| Rate for Payer: Humana ChoiceCare |
$289.12
|
| Rate for Payer: Multiplan All |
$1,011.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$667.20
|
| Rate for Payer: OMNI Networks Commercial |
$778.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,000.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,056.40
|
| Rate for Payer: Three Rivers Provider Network All |
$834.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$978.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,034.16
|
| Rate for Payer: Zelis Auto |
$444.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$556.00
|
| Rate for Payer: Zelis Worker's Compensation |
$303.58
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$916.74
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
20312034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$250.27 |
| Max. Negotiated Rate |
$870.90 |
| Rate for Payer: Cash Price |
$550.04
|
| Rate for Payer: Cigna Commercial |
$779.23
|
| Rate for Payer: First Health Commercial |
$825.07
|
| Rate for Payer: First Health Workers Compensation |
$353.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.07
|
| Rate for Payer: GEHA Commercial |
$641.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.07
|
| Rate for Payer: Multiplan All |
$834.23
|
| Rate for Payer: OMNI Networks Commercial |
$641.72
|
| Rate for Payer: One Health Plan PPO/POS |
$825.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$870.90
|
| Rate for Payer: Three Rivers Provider Network All |
$687.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.57
|
| Rate for Payer: Zelis Auto |
$366.70
|
| Rate for Payer: Zelis Worker's Compensation |
$250.27
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$1,112.00
|
|
| Hospital Charge Code |
8150012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.58 |
| Max. Negotiated Rate |
$1,056.40 |
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cigna Commercial |
$945.20
|
| Rate for Payer: First Health Commercial |
$1,000.80
|
| Rate for Payer: First Health Workers Compensation |
$429.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,000.80
|
| Rate for Payer: GEHA Commercial |
$778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,000.80
|
| Rate for Payer: Multiplan All |
$1,011.92
|
| Rate for Payer: OMNI Networks Commercial |
$778.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,000.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,056.40
|
| Rate for Payer: Three Rivers Provider Network All |
$834.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,034.16
|
| Rate for Payer: Zelis Auto |
$444.80
|
| Rate for Payer: Zelis Worker's Compensation |
$303.58
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
21600181
|
|
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 |
$317.40
|
| 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 |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$423.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| 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 |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| 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 |
$502.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| 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 |
$491.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
21600181
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$144.42 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$370.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
6112034
|
|
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 |
$317.40
|
| 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 |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$423.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| 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 |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| 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 |
$502.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| 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 |
$491.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$916.74
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
20312034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$870.90 |
| 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 |
$550.04
|
| 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 |
$550.04
|
| Rate for Payer: Cash Price |
$550.04
|
| Rate for Payer: Cigna Commercial |
$779.23
|
| Rate for Payer: First Health Commercial |
$825.07
|
| Rate for Payer: First Health Workers Compensation |
$353.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.07
|
| Rate for Payer: GEHA Commercial |
$733.39
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.07
|
| 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 |
$834.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$641.72
|
| Rate for Payer: One Health Plan PPO/POS |
$825.07
|
| 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 |
$870.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$687.55
|
| 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 |
$852.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$366.70
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$250.27
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
6112034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.42 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$370.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN 2.5CM/<
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
6112041
|
|
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 |
$276.00
|
| 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 |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$368.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| 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 |
$418.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| 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 |
$437.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| 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 |
$427.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN 2.5CM/<
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
8150014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| Rate for Payer: Humana ChoiceCare |
$218.40
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$504.00
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$739.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$420.00
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN 2.5CM/<
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
6112041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$322.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN 2.5CM/<
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
21600182
|
|
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 |
$276.00
|
| 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 |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$368.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| 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 |
$418.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| 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 |
$437.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| 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 |
$427.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN 2.5CM/<
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
21600182
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$322.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN 2.5CM/<
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
8150014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$588.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN2.6-7.5CM
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
6112042
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN2.6-7.5CM
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
21600102
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN2.6-7.5CM
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
6112042
|
|
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 |
$307.20
|
| 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 |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| 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 |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| 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 |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| 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 |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN2.6-7.5CM
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
21600102
|
|
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 |
$307.20
|
| 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 |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| 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 |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| 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 |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| 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 |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN2.6-7.5CM
|
Facility
|
OP
|
$1,095.00
|
|
| Hospital Charge Code |
8150015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: First Health Workers Compensation |
$422.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$876.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| Rate for Payer: Humana ChoiceCare |
$284.70
|
| Rate for Payer: Multiplan All |
$996.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$657.00
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,040.25
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$963.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,018.35
|
| Rate for Payer: Zelis Auto |
$438.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.50
|
| Rate for Payer: Zelis Worker's Compensation |
$298.94
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN2.6-7.5CM
|
Facility
|
IP
|
$1,095.00
|
|
| Hospital Charge Code |
8150015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.94 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: First Health Workers Compensation |
$422.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$766.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| Rate for Payer: Multiplan All |
$996.45
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,040.25
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,018.35
|
| Rate for Payer: Zelis Auto |
$438.00
|
| Rate for Payer: Zelis Worker's Compensation |
$298.94
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN7.6-12.5C
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
6112044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$1,162.48 |
| 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 |
$330.00
|
| 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 |
$581.24
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$440.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| 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 |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$150.15
|
|
