|
UC XR ABD 1V
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
21600362
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$457.90 |
| 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 |
$289.20
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$37.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| 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 |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| 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 |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$409.70
|
| 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 |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$26.31
|
|
|
UC XR ABD 2V
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
21600363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$45.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$476.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| 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 |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$143.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$506.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$32.39
|
|
|
UC XR ABD 2V
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
21600363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$45.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$417.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.39
|
|
|
UC XR ABD 3V
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
21600365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$53.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$490.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.71
|
|
|
UC XR ABD 3V
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
21600365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$53.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$560.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| 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 |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$143.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$595.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$37.71
|
|
|
UC XR ABD W/CHEST
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
2474022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$59.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.41
|
|
|
UC XR ABD W/CHEST
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
2474022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$810.35 |
| 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 |
$511.80
|
| 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 |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$59.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| 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 |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| 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 |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$725.05
|
| 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 |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$42.41
|
|
|
UC XR A/C JNTS BILAT
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
21600361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$43.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Worker's Compensation |
$30.56
|
|
|
UC XR A/C JNTS BILAT
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
21600361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$550.05 |
| 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 |
$347.40
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$43.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| 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 |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| 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 |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$492.15
|
| 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 |
$538.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$30.56
|
|
|
UC XR ANKLE 2V
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21600368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
UC XR ANKLE 2V
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21600368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$483.55 |
| 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 |
$305.40
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| 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 |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| 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 |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$432.65
|
| 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 |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$203.60
|
| 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
|
|
|
UC XR ANKLE 2V RIGHT
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21600369
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
UC XR ANKLE 2V RIGHT
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21600369
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$483.55 |
| 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 |
$305.40
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| 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 |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| 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 |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$432.65
|
| 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 |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$203.60
|
| 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
|
|
|
UC XR ANKLE 3V
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
21600366
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$431.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR ANKLE 3V
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
21600366
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$585.20 |
| 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 |
$369.60
|
| 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 |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| 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 |
$560.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| 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 |
$585.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$523.60
|
| 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 |
$572.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR ANKLE 3V RIGHT
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
21600367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$585.20 |
| 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 |
$369.60
|
| 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 |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| 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 |
$560.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| 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 |
$585.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$523.60
|
| 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 |
$572.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR ANKLE 3V RIGHT
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
21600367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$431.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR BONE AGE W & H
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
21600370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$243.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.05
|
|
|
UC XR BONE AGE W & H
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
21600370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$330.60 |
| 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 |
$208.80
|
| 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 |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$278.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| 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 |
$316.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| 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 |
$330.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| 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 |
$323.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$22.05
|
|
|
UC XR BONE LENGTH STUDIES
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
21600371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$391.40 |
| 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 |
$247.20
|
| 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 |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$329.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| 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 |
$374.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| 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 |
$391.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$350.20
|
| 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 |
$383.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
UC XR BONE LENGTH STUDIES
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
21600371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$288.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
UC XR BONE SURVEY COMP
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
21600430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$119.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$860.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| 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 |
$193.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$223.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$193.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$913.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$84.82
|
|
|
UC XR BONE SURVEY COMP
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
21600430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$119.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$752.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.82
|
|
|
UC XR BONE SURVEY INFANT
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
21600372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$780.30
|
| Rate for Payer: First Health Commercial |
$826.20
|
| Rate for Payer: First Health Workers Compensation |
$122.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$826.20
|
| Rate for Payer: GEHA Commercial |
$642.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$826.20
|
| Rate for Payer: Multiplan All |
$835.38
|
| Rate for Payer: OMNI Networks Commercial |
$642.60
|
| Rate for Payer: One Health Plan PPO/POS |
$826.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$872.10
|
| Rate for Payer: Three Rivers Provider Network All |
$688.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$853.74
|
| Rate for Payer: Zelis Auto |
$367.20
|
| Rate for Payer: Zelis Worker's Compensation |
$86.69
|
|
|
UC XR BONE SURVEY INFANT
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
21600372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$872.10 |
| 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 |
$550.80
|
| 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 |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$780.30
|
| Rate for Payer: First Health Commercial |
$826.20
|
| Rate for Payer: First Health Workers Compensation |
$122.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$826.20
|
| Rate for Payer: GEHA Commercial |
$734.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$826.20
|
| 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 |
$835.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$642.60
|
| Rate for Payer: One Health Plan PPO/POS |
$826.20
|
| 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 |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$688.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$780.30
|
| 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 |
$853.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$367.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$86.69
|
|
