|
X-RAY FEMUR 2 OR MORE VIEWS
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
8230071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$50.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$35.55
|
|
|
X-RAY HIP BILATERAL 2 VIEW
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
8230067
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$43.75
|
|
|
X-RAY HIP BILATERAL 2 VIEW
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
8230067
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$345.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$43.75
|
|
|
X-RAY HIP BILATERAL 3/4 VIEW
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
8230068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.52 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$75.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.52
|
|
|
X-RAY HIP BILATERAL 3/4 VIEW
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
8230068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.52 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$75.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$345.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$53.52
|
|
|
X-RAY HIP BILATERAL 5 OR MORE VIEWS
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
8230069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$87.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$625.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$62.10
|
|
|
X-RAY HIP BILATERAL 5 OR MORE VIEWS
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
8230069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$87.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$62.10
|
|
|
X-RAY HIP UNILATERAL 1 VIEW
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
8230064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
X-RAY HIP UNILATERAL 1 VIEW
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
8230064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$167.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$86.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
X-RAY HIP UNILATERAL 2/3 VIEWS
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
8230065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
|
X-RAY HIP UNILATERAL 2/3 VIEWS
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
8230065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$167.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
|
X-RAY HIP UNILATERAL 4 OR MORE VIEWS
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
8230066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$80.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$56.64
|
|
|
X-RAY HIP UNILATERAL 4 OR MORE VIEWS
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
8230066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$201.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$80.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$56.64
|
|
|
X-RAY STERNO CLAVICAL JOINT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
8871130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$49.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$35.06
|
|
|
X-RAY STERNO CLAVICAL JOINT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
8871130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$297.35 |
| 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 |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$49.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$266.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$35.06
|
|
|
X-RAY STERNO CLAVICAL JOINT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
8271130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$49.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Worker's Compensation |
$35.06
|
|
|
X-RAY STERNO CLAVICAL JOINT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
8271130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$297.35 |
| 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 |
$187.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: First Health Workers Compensation |
$49.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$266.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$35.06
|
|
|
XR BABYGRAM
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
2496006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$230.85 |
| 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 |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$35.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$194.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$206.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$25.45
|
|
|
XR BABYGRAM
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
2496006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$35.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$170.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.45
|
|
|
XR BONE AGE STUDY
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
2400067
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.05
|
|
|
XR BONE AGE STUDY
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
2400067
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$428.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$22.05
|
|
|
XR BONE LGTH STUDY
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
2406040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
XR BONE LGTH STUDY
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
2406040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$355.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: First Health Commercial |
$532.80
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$532.80
|
| Rate for Payer: GEHA Commercial |
$473.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$532.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$538.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$414.40
|
| Rate for Payer: One Health Plan PPO/POS |
$532.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$562.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$444.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$503.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$550.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$236.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
XR BONE SURVEY COMP
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
2400218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$1,244.50 |
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,113.50
|
| Rate for Payer: First Health Commercial |
$1,179.00
|
| Rate for Payer: First Health Workers Compensation |
$119.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,179.00
|
| Rate for Payer: GEHA Commercial |
$917.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,179.00
|
| Rate for Payer: Multiplan All |
$1,192.10
|
| Rate for Payer: OMNI Networks Commercial |
$917.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,179.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,244.50
|
| Rate for Payer: Three Rivers Provider Network All |
$982.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,218.30
|
| Rate for Payer: Zelis Auto |
$524.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.82
|
|
|
XR BONE SURVEY COMP
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
2400218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$1,244.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$786.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$189.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,113.50
|
| Rate for Payer: First Health Commercial |
$1,179.00
|
| Rate for Payer: First Health Workers Compensation |
$119.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,179.00
|
| Rate for Payer: GEHA Commercial |
$1,048.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,179.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$193.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,192.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$917.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,179.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$223.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$193.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,244.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$982.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,218.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$524.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$84.82
|
|
