|
UC XR SHOULDER COM
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
21600449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR SHOULDER COM
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
21673030
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR SHOULDER COM
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
21673030
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$380.95 |
| 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 |
$240.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| 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 |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$160.40
|
| 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 SHOULDER COM
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
21600449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$380.95 |
| 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 |
$240.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$340.85
|
| 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 |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$160.40
|
| 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 SHOULDER COM RIGHT
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
21600450
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$380.95 |
| 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 |
$240.60
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$340.85
|
| 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 |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$160.40
|
| 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 SHOULDER COM RIGHT
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
21600450
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR SI JOINTS 3+VWS
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
21600451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$403.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
UC XR SI JOINTS 3+VWS
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
21600451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$346.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$461.60
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| 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 |
$525.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$490.45
|
| 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 |
$536.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
UC XR SINUSES 3+VWS
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
21600452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.20
|
| 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 |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$511.70
|
| 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 |
$559.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
UC XR SINUSES 3+VWS
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
21600452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$421.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
UC XR SKULL 4+VWS
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
21600453
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$679.25 |
| 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 |
$429.00
|
| 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 |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$607.75
|
| Rate for Payer: First Health Commercial |
$643.50
|
| Rate for Payer: First Health Workers Compensation |
$55.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$643.50
|
| Rate for Payer: GEHA Commercial |
$572.00
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$643.50
|
| 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 |
$650.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$500.50
|
| Rate for Payer: One Health Plan PPO/POS |
$643.50
|
| 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 |
$679.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$536.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$607.75
|
| 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 |
$664.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$286.00
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$39.19
|
|
|
UC XR SKULL 4+VWS
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
21600453
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$679.25 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$607.75
|
| Rate for Payer: First Health Commercial |
$643.50
|
| Rate for Payer: First Health Workers Compensation |
$55.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$643.50
|
| Rate for Payer: GEHA Commercial |
$500.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$643.50
|
| Rate for Payer: Multiplan All |
$650.65
|
| Rate for Payer: OMNI Networks Commercial |
$500.50
|
| Rate for Payer: One Health Plan PPO/POS |
$643.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$679.25
|
| Rate for Payer: Three Rivers Provider Network All |
$536.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.95
|
| Rate for Payer: Zelis Auto |
$286.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.19
|
|
|
UC XR SOFT TISSUE NECK
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
21600432
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$37.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Worker's Compensation |
$26.86
|
|
|
UC XR SOFT TISSUE NECK
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
21600432
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$212.80 |
| 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 |
$134.40
|
| 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 |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$37.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| 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 |
$203.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| 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 |
$212.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$190.40
|
| 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 |
$208.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$26.86
|
|
|
UC XR STERNUM 2+VWS
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
21600455
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$40.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
UC XR STERNUM 2+VWS
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
21600455
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$387.60 |
| 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 |
$244.80
|
| 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 |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$40.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| 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 |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| 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 |
$387.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$346.80
|
| 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 |
$379.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
UC XR TIB/FIB
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
21600457
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| 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 |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| 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 |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| 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 |
$439.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$393.55
|
| 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 |
$430.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
UC XR TIB/FIB
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
21600457
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
UC XR TIB/FIB RIGHT
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
21600458
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| 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 |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| 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 |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| 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 |
$439.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$393.55
|
| 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 |
$430.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
UC XR TIB/FIB RIGHT
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
21600458
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
UC XR T-L SPINE 2 VIEWS
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
21600459
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$394.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR T-L SPINE 2 VIEWS
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
21600459
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$337.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$85.32
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$450.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| 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 |
$512.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$478.55
|
| 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 |
$523.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
UC XR TM JOINTS
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
21600460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: First Health Workers Compensation |
$63.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$314.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.98
|
|
|
UC XR TM JOINTS
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
21600460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$426.55 |
| 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 |
$269.40
|
| 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 |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: First Health Workers Compensation |
$63.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$359.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| 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 |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| 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 |
$426.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$381.65
|
| 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 |
$417.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$44.98
|
|
|
UC XR TOE
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
21600461
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$221.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
