|
XR C-SPINE 6+ VWS OB/FL/EX
|
Facility
|
IP
|
$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: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$74.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$52.87
|
|
|
XR DYSPHAGIA SWALLOW
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
2400197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$158.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$821.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$112.12
|
|
|
XR DYSPHAGIA SWALLOW
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
2400197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$158.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$112.12
|
|
|
XR ELBOW 2 VIEWS LEFT
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
8230020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$305.90 |
| 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 |
$193.20
|
| 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 |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| 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 |
$293.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| 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 |
$305.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$273.70
|
| 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 |
$299.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
XR ELBOW 2 VIEWS LEFT
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
8230020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$225.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| Rate for Payer: Multiplan All |
$293.02
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$305.90
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$299.46
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
XR ELBOW 2 VIEWS RIGHT
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
8250006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$225.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| Rate for Payer: Multiplan All |
$293.02
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$305.90
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$299.46
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
XR ELBOW 2 VIEWS RIGHT
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
8250006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$305.90 |
| 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 |
$193.20
|
| 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 |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$273.70
|
| Rate for Payer: First Health Commercial |
$289.80
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$289.80
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$289.80
|
| 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 |
$293.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$225.40
|
| Rate for Payer: One Health Plan PPO/POS |
$289.80
|
| 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 |
$305.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$241.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$273.70
|
| 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 |
$299.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$128.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
XR ELBOW 2 VW
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
2450080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$345.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
XR ELBOW 2 VW
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
2450080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$394.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| 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 |
$448.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$419.05
|
| 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 |
$458.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
XR ELBOW COMP
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
2453080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$434.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR ELBOW COMP
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
2453080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| 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 |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$527.85
|
| 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 |
$577.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR ELBOW COMPLETE LEFT
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
8230021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$307.80 |
| 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 |
$194.40
|
| 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 |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| 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 |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| 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 |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| 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 |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR ELBOW COMPLETE LEFT
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
8230021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR ELBOW COMPLETE RIGHT
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
8250007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$307.80 |
| 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 |
$194.40
|
| 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 |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| 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 |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| 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 |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$275.40
|
| 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 |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR ELBOW COMPLETE RIGHT
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
8250007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR FACIAL BONES <3VWS
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
2470004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$456.95 |
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$38.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$336.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Worker's Compensation |
$27.43
|
|
|
XR FACIAL BONES <3VWS
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
2470004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$456.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$38.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$384.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| 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 |
$437.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$408.85
|
| 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 |
$447.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.43
|
|
|
XR FACIAL BONES COMP
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
2400150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$690.65 |
| 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 |
$436.20
|
| 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 |
$436.20
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$56.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$581.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| 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 |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$617.95
|
| 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 |
$676.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$39.91
|
|
|
XR FACIAL BONES COMP
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
2400150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$56.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$508.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Worker's Compensation |
$39.91
|
|
|
XR FEMUR 1V
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
2410097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$43.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.46
|
|
|
XR FEMUR 1V
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
2410097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$429.40 |
| 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 |
$271.20
|
| 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 |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$43.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| 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 |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| 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 |
$429.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$384.20
|
| 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 |
$420.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$30.46
|
|
|
XR FEMUR COMP
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
2410098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$537.70 |
| 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 |
$339.60
|
| 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 |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$50.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$452.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| 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 |
$537.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$481.10
|
| 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 |
$526.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$35.55
|
|
|
XR FEMUR COMP
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
2410098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$481.10
|
| Rate for Payer: First Health Commercial |
$509.40
|
| Rate for Payer: First Health Workers Compensation |
$50.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$509.40
|
| Rate for Payer: GEHA Commercial |
$396.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$509.40
|
| Rate for Payer: Multiplan All |
$515.06
|
| Rate for Payer: OMNI Networks Commercial |
$396.20
|
| Rate for Payer: One Health Plan PPO/POS |
$509.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$537.70
|
| Rate for Payer: Three Rivers Provider Network All |
$424.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$526.38
|
| Rate for Payer: Zelis Auto |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.55
|
|
|
XR FINGER
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
2450089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$446.50 |
| 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 |
$282.00
|
| 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 |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$45.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$376.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| 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 |
$427.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| 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 |
$446.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$399.50
|
| 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 |
$437.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.23
|
|
|
XR FINGER
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
2450089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$45.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$329.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.23
|
|
