|
SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
6112011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
6112013
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
6112013
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
21600104
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$326.31
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
8512013
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cigna Commercial |
$277.36
|
| Rate for Payer: First Health Commercial |
$293.68
|
| Rate for Payer: First Health Workers Compensation |
$125.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.68
|
| Rate for Payer: GEHA Commercial |
$261.05
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.68
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$296.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$228.42
|
| Rate for Payer: One Health Plan PPO/POS |
$293.68
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.99
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$244.73
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$130.52
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.08
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
8150006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$533.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$337.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$477.70
|
| Rate for Payer: First Health Commercial |
$505.80
|
| Rate for Payer: First Health Workers Compensation |
$216.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$505.80
|
| Rate for Payer: GEHA Commercial |
$449.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$505.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$511.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$393.40
|
| Rate for Payer: One Health Plan PPO/POS |
$505.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$533.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$421.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$522.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$224.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$153.43
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$326.31
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
8512013
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$309.99 |
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cigna Commercial |
$277.36
|
| Rate for Payer: First Health Commercial |
$293.68
|
| Rate for Payer: First Health Workers Compensation |
$125.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.68
|
| Rate for Payer: GEHA Commercial |
$228.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.68
|
| Rate for Payer: Multiplan All |
$296.94
|
| Rate for Payer: OMNI Networks Commercial |
$228.42
|
| Rate for Payer: One Health Plan PPO/POS |
$293.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.99
|
| Rate for Payer: Three Rivers Provider Network All |
$244.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.47
|
| Rate for Payer: Zelis Auto |
$130.52
|
| Rate for Payer: Zelis Worker's Compensation |
$89.08
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$326.31
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
7212013
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cigna Commercial |
$277.36
|
| Rate for Payer: First Health Commercial |
$293.68
|
| Rate for Payer: First Health Workers Compensation |
$125.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.68
|
| Rate for Payer: GEHA Commercial |
$261.05
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.68
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$296.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$228.42
|
| Rate for Payer: One Health Plan PPO/POS |
$293.68
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.99
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$244.73
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$130.52
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.08
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
21600104
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
8150006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.43 |
| Max. Negotiated Rate |
$533.90 |
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$477.70
|
| Rate for Payer: First Health Commercial |
$505.80
|
| Rate for Payer: First Health Workers Compensation |
$216.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$505.80
|
| Rate for Payer: GEHA Commercial |
$393.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$505.80
|
| Rate for Payer: Multiplan All |
$511.42
|
| Rate for Payer: OMNI Networks Commercial |
$393.40
|
| Rate for Payer: One Health Plan PPO/POS |
$505.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$533.90
|
| Rate for Payer: Three Rivers Provider Network All |
$421.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$522.66
|
| Rate for Payer: Zelis Auto |
$224.80
|
| Rate for Payer: Zelis Worker's Compensation |
$153.43
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$326.31
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
7212013
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$309.99 |
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Cigna Commercial |
$277.36
|
| Rate for Payer: First Health Commercial |
$293.68
|
| Rate for Payer: First Health Workers Compensation |
$125.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.68
|
| Rate for Payer: GEHA Commercial |
$228.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.68
|
| Rate for Payer: Multiplan All |
$296.94
|
| Rate for Payer: OMNI Networks Commercial |
$228.42
|
| Rate for Payer: One Health Plan PPO/POS |
$293.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.99
|
| Rate for Payer: Three Rivers Provider Network All |
$244.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.47
|
| Rate for Payer: Zelis Auto |
$130.52
|
| Rate for Payer: Zelis Worker's Compensation |
$89.08
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
21600172
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$615.00
|
|
| Hospital Charge Code |
8150007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$522.75
|
| Rate for Payer: First Health Commercial |
$553.50
|
| Rate for Payer: First Health Workers Compensation |
$237.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$553.50
|
| Rate for Payer: GEHA Commercial |
$492.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$553.50
|
| Rate for Payer: Humana ChoiceCare |
$159.90
|
| Rate for Payer: Multiplan All |
$559.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$369.00
|
| Rate for Payer: OMNI Networks Commercial |
$430.50
|
| Rate for Payer: One Health Plan PPO/POS |
$553.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$584.25
|
| Rate for Payer: Three Rivers Provider Network All |
$461.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$541.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.95
|
| Rate for Payer: Zelis Auto |
$246.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.50
|
| Rate for Payer: Zelis Worker's Compensation |
$167.90
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
6112014
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$187.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
IP
|
$615.00
|
|
| Hospital Charge Code |
8150007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.90 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$522.75
|
| Rate for Payer: First Health Commercial |
$553.50
|
| Rate for Payer: First Health Workers Compensation |
$237.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$553.50
|
| Rate for Payer: GEHA Commercial |
$430.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$553.50
|
| Rate for Payer: Multiplan All |
$559.65
|
| Rate for Payer: OMNI Networks Commercial |
$430.50
|
| Rate for Payer: One Health Plan PPO/POS |
$553.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$584.25
|
| Rate for Payer: Three Rivers Provider Network All |
$461.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.95
|
| Rate for Payer: Zelis Auto |
$246.00
|
| Rate for Payer: Zelis Worker's Compensation |
$167.90
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
6112014
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$163.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
21600172
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$198.90
|
| Rate for Payer: First Health Commercial |
$210.60
|
| Rate for Payer: First Health Workers Compensation |
$90.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$210.60
|
| Rate for Payer: GEHA Commercial |
$187.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$210.60
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$212.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$163.80
|
| Rate for Payer: One Health Plan PPO/POS |
$210.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$175.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$217.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$93.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.88
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK
|
Facility
|
OP
|
$808.83
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9612001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$768.39 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$485.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$485.30
|
| Rate for Payer: Cash Price |
$485.30
|
| Rate for Payer: Cigna Commercial |
$687.51
|
| Rate for Payer: First Health Commercial |
$727.95
|
| Rate for Payer: First Health Workers Compensation |
$312.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.95
|
| Rate for Payer: GEHA Commercial |
$647.06
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.95
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$736.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$566.18
|
| Rate for Payer: One Health Plan PPO/POS |
$727.95
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$768.39
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$606.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$752.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$323.53
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$220.81
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK
|
Facility
|
IP
|
$808.83
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9612001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.81 |
| Max. Negotiated Rate |
$768.39 |
| Rate for Payer: Cash Price |
$485.30
|
| Rate for Payer: Cigna Commercial |
$687.51
|
| Rate for Payer: First Health Commercial |
$727.95
|
| Rate for Payer: First Health Workers Compensation |
$312.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.95
|
| Rate for Payer: GEHA Commercial |
$566.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.95
|
| Rate for Payer: Multiplan All |
$736.04
|
| Rate for Payer: OMNI Networks Commercial |
$566.18
|
| Rate for Payer: One Health Plan PPO/POS |
$727.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$768.39
|
| Rate for Payer: Three Rivers Provider Network All |
$606.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$752.21
|
| Rate for Payer: Zelis Auto |
$323.53
|
| Rate for Payer: Zelis Worker's Compensation |
$220.81
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9312001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9312001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$260.07
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8512001
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cigna Commercial |
$221.06
|
| Rate for Payer: First Health Commercial |
$234.06
|
| Rate for Payer: First Health Workers Compensation |
$100.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.06
|
| Rate for Payer: GEHA Commercial |
$182.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.06
|
| Rate for Payer: Multiplan All |
$236.66
|
| Rate for Payer: OMNI Networks Commercial |
$182.05
|
| Rate for Payer: One Health Plan PPO/POS |
$234.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.07
|
| Rate for Payer: Three Rivers Provider Network All |
$195.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.87
|
| Rate for Payer: Zelis Auto |
$104.03
|
| Rate for Payer: Zelis Worker's Compensation |
$71.00
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
6112001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8150001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
20300100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
