|
XR BONE SURVEY INFANT
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
2400191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$323.95 |
| 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 |
$204.60
|
| 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 |
$100.97
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$122.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$272.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| 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 |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$289.85
|
| 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 |
$317.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$86.69
|
|
|
XR BONE SURVEY INFANT
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
2400191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$289.85
|
| Rate for Payer: First Health Commercial |
$306.90
|
| Rate for Payer: First Health Workers Compensation |
$122.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.90
|
| Rate for Payer: GEHA Commercial |
$238.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.90
|
| Rate for Payer: Multiplan All |
$310.31
|
| Rate for Payer: OMNI Networks Commercial |
$238.70
|
| Rate for Payer: One Health Plan PPO/POS |
$306.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.95
|
| Rate for Payer: Three Rivers Provider Network All |
$255.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$317.13
|
| Rate for Payer: Zelis Auto |
$136.40
|
| Rate for Payer: Zelis Worker's Compensation |
$86.69
|
|
|
XR BONE SURVEY LMTD METS
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
2400190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$818.90 |
| 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 |
$517.20
|
| 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 |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$732.70
|
| Rate for Payer: First Health Commercial |
$775.80
|
| Rate for Payer: First Health Workers Compensation |
$78.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$775.80
|
| Rate for Payer: GEHA Commercial |
$689.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$775.80
|
| 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 |
$784.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$603.40
|
| Rate for Payer: One Health Plan PPO/POS |
$775.80
|
| 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 |
$818.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$646.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$732.70
|
| 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 |
$801.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$344.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$55.60
|
|
|
XR BONE SURVEY LMTD METS
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
2400190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$818.90 |
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$732.70
|
| Rate for Payer: First Health Commercial |
$775.80
|
| Rate for Payer: First Health Workers Compensation |
$78.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$775.80
|
| Rate for Payer: GEHA Commercial |
$603.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$775.80
|
| Rate for Payer: Multiplan All |
$784.42
|
| Rate for Payer: OMNI Networks Commercial |
$603.40
|
| Rate for Payer: One Health Plan PPO/POS |
$775.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$818.90
|
| Rate for Payer: Three Rivers Provider Network All |
$646.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$801.66
|
| Rate for Payer: Zelis Auto |
$344.80
|
| Rate for Payer: Zelis Worker's Compensation |
$55.60
|
|
|
XR CHEST 1V
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
2400107
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: First Health Workers Compensation |
$32.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| 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 |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$413.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$22.62
|
|
|
XR CHEST 1V
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
2400107
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: First Health Workers Compensation |
$32.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.62
|
|
|
XR CHEST 2VWS
|
Facility
|
OP
|
$570.60
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
2400104
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$542.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$342.36
|
| Rate for Payer: Cash Price |
$342.36
|
| Rate for Payer: Cigna Commercial |
$485.01
|
| Rate for Payer: First Health Commercial |
$513.54
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.54
|
| Rate for Payer: GEHA Commercial |
$456.48
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.54
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$519.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$399.42
|
| Rate for Payer: One Health Plan PPO/POS |
$513.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$427.95
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$485.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$228.24
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
XR CHEST 2VWS
|
Facility
|
IP
|
$570.60
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
2400104
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$542.07 |
| Rate for Payer: Cash Price |
$342.36
|
| Rate for Payer: Cash Price |
$342.36
|
| Rate for Payer: Cigna Commercial |
$485.01
|
| Rate for Payer: First Health Commercial |
$513.54
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.54
|
| Rate for Payer: GEHA Commercial |
$399.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.54
|
| Rate for Payer: Multiplan All |
$519.25
|
| Rate for Payer: OMNI Networks Commercial |
$399.42
|
| Rate for Payer: One Health Plan PPO/POS |
$513.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.07
|
| Rate for Payer: Three Rivers Provider Network All |
$427.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.66
|
| Rate for Payer: Zelis Auto |
$228.24
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
|
XR CHEST 3VWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
2400105
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: First Health Workers Compensation |
$52.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Worker's Compensation |
$37.19
|
|
|
XR CHEST 3VWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
2400105
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: First Health Workers Compensation |
$52.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$513.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$37.19
|
|
|
XR CHEST 4VWS
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
2400106
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$431.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$57.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$575.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$143.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$611.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
XR CHEST 4VWS
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
2400106
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$57.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$503.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
XR CHOLANGIO OPER
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
2400061
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$1,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Humana ChoiceCare |
$332.80
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$768.00
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,126.40
|
| Rate for Payer: United Healthcare Commercial |
$1,088.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$640.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.76
|
|
|
XR CHOLANGIO OPER
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
2400061
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$896.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.76
|
|
|
XR CLAVICLE
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
2450031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| 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 |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$469.20
|
| 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 |
$513.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR CLAVICLE
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
2450031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR CLAVICLE COMP LEFT
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
8230014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR CLAVICLE COMP LEFT
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
8230014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$440.80 |
| 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 |
$278.40
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| 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 |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| 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 |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$394.40
|
| 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 |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR CLAVICLE COMP RIGHT
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
8250001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| Rate for Payer: Multiplan All |
$422.24
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$431.52
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR CLAVICLE COMP RIGHT
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
8250001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$440.80 |
| 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 |
$278.40
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: First Health Commercial |
$417.60
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$417.60
|
| Rate for Payer: GEHA Commercial |
$371.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$417.60
|
| 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 |
$422.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$324.80
|
| Rate for Payer: One Health Plan PPO/POS |
$417.60
|
| 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 |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$440.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$348.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$394.40
|
| 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 |
$431.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$185.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR C-SPINE 2/3 VWS
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
2400020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$47.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$541.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$33.65
|
|
|
XR C-SPINE 2/3 VWS
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
2400020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$47.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.65
|
|
|
XR C-SPINE 4/5 VWS
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
2400021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: First Health Workers Compensation |
$63.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.25
|
|
|
XR C-SPINE 4/5 VWS
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
2400021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: First Health Workers Compensation |
$63.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$760.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$45.25
|
|
|
XR C-SPINE 6+ VWS OB/FL/EX
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
2400199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$74.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| 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 |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$861.90
|
| 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 |
$943.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$52.87
|
|
