|
RAD EXM RSA LWR EXTR
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
4906528
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$435.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$462.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
|
RAD EXM RSA LWR EXTR
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
4906528
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
|
RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
2400093
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$434.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cigna Commercial |
$615.40
|
| Rate for Payer: First Health Commercial |
$651.60
|
| Rate for Payer: First Health Workers Compensation |
$57.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$651.60
|
| Rate for Payer: GEHA Commercial |
$579.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$651.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$658.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$506.80
|
| Rate for Payer: One Health Plan PPO/POS |
$651.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$687.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$543.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$615.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$673.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$289.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$40.76
|
|
|
RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
2400093
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cigna Commercial |
$615.40
|
| Rate for Payer: First Health Commercial |
$651.60
|
| Rate for Payer: First Health Workers Compensation |
$57.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$651.60
|
| Rate for Payer: GEHA Commercial |
$506.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$651.60
|
| Rate for Payer: Multiplan All |
$658.84
|
| Rate for Payer: OMNI Networks Commercial |
$506.80
|
| Rate for Payer: One Health Plan PPO/POS |
$651.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$687.80
|
| Rate for Payer: Three Rivers Provider Network All |
$543.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$673.32
|
| Rate for Payer: Zelis Auto |
$289.60
|
| Rate for Payer: Zelis Worker's Compensation |
$40.76
|
|
|
RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
8272220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$396.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$420.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
8272220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$346.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
RADEX SINUSES PARANASAL COMPL MIN 3VWS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
8300057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$167.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$85.85
|
| Rate for Payer: First Health Commercial |
$90.90
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.90
|
| Rate for Payer: GEHA Commercial |
$80.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.90
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$91.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$70.70
|
| Rate for Payer: One Health Plan PPO/POS |
$90.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$75.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$85.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$40.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
RADEX SINUSES PARANASAL COMPL MIN 3VWS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
8300057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$85.85
|
| Rate for Payer: First Health Commercial |
$90.90
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.90
|
| Rate for Payer: GEHA Commercial |
$70.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.90
|
| Rate for Payer: Multiplan All |
$91.91
|
| Rate for Payer: OMNI Networks Commercial |
$70.70
|
| Rate for Payer: One Health Plan PPO/POS |
$90.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.95
|
| Rate for Payer: Three Rivers Provider Network All |
$75.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.93
|
| Rate for Payer: Zelis Auto |
$40.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
RADEX SINUSES PARANASAL COMPL MIN 3VWS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
7970220
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$85.85
|
| Rate for Payer: First Health Commercial |
$90.90
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.90
|
| Rate for Payer: GEHA Commercial |
$70.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.90
|
| Rate for Payer: Multiplan All |
$91.91
|
| Rate for Payer: OMNI Networks Commercial |
$70.70
|
| Rate for Payer: One Health Plan PPO/POS |
$90.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.95
|
| Rate for Payer: Three Rivers Provider Network All |
$75.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.93
|
| Rate for Payer: Zelis Auto |
$40.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
RADEX SINUSES PARANASAL COMPL MIN 3VWS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
7970220
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$167.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$85.85
|
| Rate for Payer: First Health Commercial |
$90.90
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.90
|
| Rate for Payer: GEHA Commercial |
$80.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.90
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$91.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$70.70
|
| Rate for Payer: One Health Plan PPO/POS |
$90.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$75.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$40.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
8230003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$517.75 |
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: First Health Commercial |
$490.50
|
| Rate for Payer: First Health Workers Compensation |
$47.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$490.50
|
| Rate for Payer: GEHA Commercial |
$381.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$490.50
|
| Rate for Payer: Multiplan All |
$495.95
|
| Rate for Payer: OMNI Networks Commercial |
$381.50
|
| Rate for Payer: One Health Plan PPO/POS |
$490.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$517.75
|
| Rate for Payer: Three Rivers Provider Network All |
$408.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$506.85
|
| Rate for Payer: Zelis Auto |
$218.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.65
|
|
|
RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
8230003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$517.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: First Health Commercial |
$490.50
|
| Rate for Payer: First Health Workers Compensation |
$47.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$490.50
|
| Rate for Payer: GEHA Commercial |
$436.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$490.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$495.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$381.50
|
| Rate for Payer: One Health Plan PPO/POS |
$490.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$517.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$408.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$463.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$506.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$218.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$33.65
|
|
|
RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
8230004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$404.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$572.90
|
| Rate for Payer: First Health Commercial |
$606.60
|
| Rate for Payer: First Health Workers Compensation |
$63.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$606.60
|
| Rate for Payer: GEHA Commercial |
$539.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$606.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$613.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$471.80
|
| Rate for Payer: One Health Plan PPO/POS |
$606.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$640.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$505.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$572.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$626.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$269.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$45.25
|
|
|
RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
8230004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$572.90
|
| Rate for Payer: First Health Commercial |
$606.60
|
| Rate for Payer: First Health Workers Compensation |
$63.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$606.60
|
| Rate for Payer: GEHA Commercial |
$471.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$606.60
|
| Rate for Payer: Multiplan All |
$613.34
|
| Rate for Payer: OMNI Networks Commercial |
$471.80
|
| Rate for Payer: One Health Plan PPO/POS |
$606.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$640.30
|
| Rate for Payer: Three Rivers Provider Network All |
$505.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$626.82
|
| Rate for Payer: Zelis Auto |
$269.60
|
| Rate for Payer: Zelis Worker's Compensation |
$45.25
|
|
|
RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
8230005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$647.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$409.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$74.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$545.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$579.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$52.87
|
|
|
RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
8230005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$647.90 |
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$74.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$477.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.87
|
|
|
RADEX SPINE LMBSCRL COM W/BNDG VWS MIN 6
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
8230012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$75.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$657.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Worker's Compensation |
$53.37
|
|
|
RADEX SPINE LMBSCRL COM W/BNDG VWS MIN 6
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
8230012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$75.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$751.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$798.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$53.37
|
|
|
RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
8230010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$47.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$447.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.93
|
|
|
RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
8230010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$47.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.93
|
|
|
RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
8230011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$61.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$552.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$43.55
|
|
|
RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
8230011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$61.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.55
|
|
|
RADEX SPINE THORACIC 2 VIEWS
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
8230006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$417.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
RADEX SPINE THORACIC 2 VIEWS
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
8230006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$358.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$507.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
RADEX SPINE THORACIC 3 VIEWS
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
8230007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$505.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
