|
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
|
|
|
RADEX SPINE THORACOLUMBAR JUNCT MIN 2VWS
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
8230008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$394.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
RADEX SPINE THORACOLUMBAR JUNCT MIN 2VWS
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
8230008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$534.85 |
| 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 |
$337.80
|
| 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 |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$450.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| 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 |
$512.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| 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 |
$534.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$478.55
|
| 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 |
$523.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
RADICAL RESECTION OF ELBOW
|
Facility
|
OP
|
$2,406.00
|
|
|
Service Code
|
CPT 24149
|
| Hospital Charge Code |
6124149
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.84 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,443.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cigna Commercial |
$2,045.10
|
| Rate for Payer: First Health Commercial |
$2,165.40
|
| Rate for Payer: First Health Workers Compensation |
$928.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,165.40
|
| Rate for Payer: GEHA Commercial |
$1,924.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,165.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,189.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,684.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,165.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,285.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,804.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,237.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$962.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$656.84
|
|
|
RADICAL RESECTION OF ELBOW
|
Facility
|
IP
|
$2,406.00
|
|
|
Service Code
|
CPT 24149
|
| Hospital Charge Code |
6124149
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.84 |
| Max. Negotiated Rate |
$2,285.70 |
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cigna Commercial |
$2,045.10
|
| Rate for Payer: First Health Commercial |
$2,165.40
|
| Rate for Payer: First Health Workers Compensation |
$928.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,165.40
|
| Rate for Payer: GEHA Commercial |
$1,684.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,165.40
|
| Rate for Payer: Multiplan All |
$2,189.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,684.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,165.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,285.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,804.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,237.58
|
| Rate for Payer: Zelis Auto |
$962.40
|
| Rate for Payer: Zelis Worker's Compensation |
$656.84
|
|
|
RADIOFREQ ABLTJ NRV NRVTG SI JT W/IMG GD
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
6164625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.62 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,579.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,579.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,043.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: First Health Workers Compensation |
$232.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$482.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,084.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,407.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,084.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,084.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$164.62
|
|
|
RADIOFREQ ABLTJ NRV NRVTG SI JT W/IMG GD
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
6164625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.62 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: First Health Workers Compensation |
$232.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$422.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Worker's Compensation |
$164.62
|
|
|
RADIOLOGIC EXAM CHEST 2 VIEWS
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
8200001
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$283.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
RADIOLOGIC EXAM CHEST 2 VIEWS
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
8200001
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$324.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| 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 |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$344.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
RADIOLOGIC EXAMINATION SKULL 4/> VIEWS
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
2400008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$559.55 |
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$500.65
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: First Health Workers Compensation |
$44.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$530.10
|
| Rate for Payer: GEHA Commercial |
$412.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$530.10
|
| Rate for Payer: Multiplan All |
$535.99
|
| Rate for Payer: OMNI Networks Commercial |
$412.30
|
| Rate for Payer: One Health Plan PPO/POS |
$530.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$559.55
|
| Rate for Payer: Three Rivers Provider Network All |
$441.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$547.77
|
| Rate for Payer: Zelis Auto |
$235.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.15
|
|
|
RADIOLOGIC EXAMINATION SKULL 4/> VIEWS
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
2400008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$559.55 |
| 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 |
$353.40
|
| 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 |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$500.65
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: First Health Workers Compensation |
$44.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$530.10
|
| Rate for Payer: GEHA Commercial |
$471.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$530.10
|
| 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 |
$535.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$412.30
|
| Rate for Payer: One Health Plan PPO/POS |
$530.10
|
| 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 |
$559.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$441.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$500.65
|
| 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 |
$547.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$235.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$31.15
|
|
|
RADIOLOGIC EXAM RSA
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
4906526
|
|
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
|
|
|
RADIOLOGIC EXAM RSA
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
4906526
|
|
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
|
|
|
RADIOLOGIC EXAM SACROILIAC JNTS <3 VIEWS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
8272200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$315.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
RADIOLOGIC EXAM SACROILIAC JNTS <3 VIEWS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
8272200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$427.50 |
| 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 |
$270.00
|
| 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 |
$100.97
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$360.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| 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 |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| 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 |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$382.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
RADIOLOGIC EXAM SACROILIAC JNTS <3 VIEWS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
8872200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$427.50 |
| 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 |
$270.00
|
| 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 |
$100.97
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$360.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| 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 |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| 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 |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$382.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
RADIOLOGIC EXAM SACROILIAC JNTS <3 VIEWS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
8872200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$315.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
8899224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$548.15 |
| 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 |
$346.20
|
| 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 |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$461.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| 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 |
$525.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| 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 |
$548.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$490.45
|
| 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 |
$536.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
8899224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$403.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
8200002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$548.15 |
| 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 |
$346.20
|
| 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 |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$461.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| 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 |
$525.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| 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 |
$548.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$490.45
|
| 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 |
$536.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
8800049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$548.15 |
| 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 |
$346.20
|
| 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 |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$461.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| 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 |
$525.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| 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 |
$548.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$490.45
|
| 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 |
$536.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| 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
|
|
|
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
8800049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$403.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
8200002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$403.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
RADIOPAQUE MARKER CAPSULE, SIZE 00
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
3303143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.21 |
| Max. Negotiated Rate |
$421.80 |
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$377.40
|
| Rate for Payer: First Health Commercial |
$399.60
|
| Rate for Payer: First Health Workers Compensation |
$171.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$399.60
|
| Rate for Payer: GEHA Commercial |
$310.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$399.60
|
| Rate for Payer: Multiplan All |
$404.04
|
| Rate for Payer: OMNI Networks Commercial |
$310.80
|
| Rate for Payer: One Health Plan PPO/POS |
$399.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$421.80
|
| Rate for Payer: Three Rivers Provider Network All |
$333.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$412.92
|
| Rate for Payer: Zelis Auto |
$177.60
|
| Rate for Payer: Zelis Worker's Compensation |
$121.21
|
|
|
RADIOPAQUE MARKER CAPSULE, SIZE 00
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
3303143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$421.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$377.40
|
| Rate for Payer: First Health Commercial |
$399.60
|
| Rate for Payer: First Health Workers Compensation |
$171.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$399.60
|
| Rate for Payer: GEHA Commercial |
$355.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$399.60
|
| Rate for Payer: Humana ChoiceCare |
$115.44
|
| Rate for Payer: Multiplan All |
$404.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$266.40
|
| Rate for Payer: OMNI Networks Commercial |
$310.80
|
| Rate for Payer: One Health Plan PPO/POS |
$399.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$421.80
|
| Rate for Payer: Three Rivers Provider Network All |
$333.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$390.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$412.92
|
| Rate for Payer: Zelis Auto |
$177.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$121.21
|
|
