|
UC XR CHEST 1V
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
21600376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$442.70 |
| 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 |
$279.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$32.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$396.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$22.62
|
|
|
UC XR CHEST 1V
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
21600376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$32.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$326.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.62
|
|
|
UC XR CHEST 2VWS
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
21600377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$518.70 |
| 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 |
$327.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$464.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR CHEST 2VWS
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
21600377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$382.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR CHEST 3 VIEWS
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
21600378
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$559.55 |
| 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 |
$353.40
|
| 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 |
$85.32
|
| 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 |
$52.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$530.10
|
| Rate for Payer: GEHA Commercial |
$471.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$530.10
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$535.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| 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 |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$559.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$441.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$500.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$547.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$235.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$37.19
|
|
|
UC XR CHEST 3 VIEWS
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
21600378
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.19 |
| 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 |
$52.60
|
| 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 |
$37.19
|
|
|
UC XR CHEST 4+ VIEWS
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
21600381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$376.20 |
| 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 |
$237.60
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$336.60
|
| Rate for Payer: First Health Commercial |
$356.40
|
| Rate for Payer: First Health Workers Compensation |
$57.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$356.40
|
| Rate for Payer: GEHA Commercial |
$316.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$356.40
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$360.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$277.20
|
| Rate for Payer: One Health Plan PPO/POS |
$356.40
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$376.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$297.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$336.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$368.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$158.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
UC XR CHEST 4+ VIEWS
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
21600381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$336.60
|
| Rate for Payer: First Health Commercial |
$356.40
|
| Rate for Payer: First Health Workers Compensation |
$57.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$356.40
|
| Rate for Payer: GEHA Commercial |
$277.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$356.40
|
| Rate for Payer: Multiplan All |
$360.36
|
| Rate for Payer: OMNI Networks Commercial |
$277.20
|
| Rate for Payer: One Health Plan PPO/POS |
$356.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$376.20
|
| Rate for Payer: Three Rivers Provider Network All |
$297.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$368.28
|
| Rate for Payer: Zelis Auto |
$158.40
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
UC XR CLAVICLE
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
21600379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$524.40 |
| 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 |
$331.20
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$469.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
UC XR CLAVICLE
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
21600379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
UC XR CLAVICLE COMP RIGHT
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
21600380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$524.40 |
| 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 |
$331.20
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$469.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
UC XR CLAVICLE COMP RIGHT
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
21600380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
UC XR C-SPINE 2/3 VWS
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
21600374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$605.15 |
| 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 |
$382.20
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$47.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$541.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$33.65
|
|
|
UC XR C-SPINE 2/3 VWS
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
21600374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$47.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.65
|
|
|
UC XR C-SPINE 4/5 VWS
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
21600375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: First Health Workers Compensation |
$63.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.25
|
|
|
UC XR C-SPINE 4/5 VWS
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
21600375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$850.25 |
| 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 |
$537.00
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: First Health Workers Compensation |
$63.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$760.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$45.25
|
|
|
UC XR C-SPINE 6+ VWS OB/FL/EX
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
21600382
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.40
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$74.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$861.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$52.87
|
|
|
UC XR C-SPINE 6+ VWS OB/FL/EX
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
21600382
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$74.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$52.87
|
|
|
UC XR ELBOW 2 VIEWS RIGHT
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
21600384
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$468.35 |
| 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 |
$295.80
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$394.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$419.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR ELBOW 2 VIEWS RIGHT
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
21600384
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$345.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR ELBOW 2 VW
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
21600383
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$345.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR ELBOW 2 VW
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
21600383
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$468.35 |
| 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 |
$295.80
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$394.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$419.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR ELBOW COMP
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
21600385
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$434.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
UC XR ELBOW COMP
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
21600385
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$589.95 |
| 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 |
$372.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$527.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
UC XR ELBOW COMP RIGHT
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
21600386
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$589.95 |
| 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 |
$372.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$527.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
