|
XR OS CALCIS
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
2450052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.80
|
| 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 |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$374.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| 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 |
$425.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$397.80
|
| 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 |
$435.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
XR OS CALCIS
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
2450052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$327.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
XR OS CALCIS LEFT
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
8230044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| 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 |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| 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 |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$347.65
|
| 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 |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
XR OS CALCIS LEFT
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
8230044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
XR OS CALCIS RIGHT
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
8250023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
XR OS CALCIS RIGHT
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
8250023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| 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 |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| 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 |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$347.65
|
| 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 |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
XR PELVIS 1/2 VWS
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
8230013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.20
|
| 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 |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$249.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| 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 |
$283.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| 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 |
$296.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$265.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
|
XR PELVIS 1/2 VWS
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
2400027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$326.40
|
| 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 |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$435.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| 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 |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| 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 |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$462.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
|
XR PELVIS 1/2 VWS
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
2400027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
|
XR PELVIS 1/2 VWS
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
8230013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
|
XR PELVIS 3+ VIEWS
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
2400222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$50.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Worker's Compensation |
$35.92
|
|
|
XR PELVIS 3+ VIEWS
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
2400222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$631.75 |
| 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 |
$399.00
|
| 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 |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$50.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| 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 |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| 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 |
$631.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$565.25
|
| 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 |
$618.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$35.92
|
|
|
XR RIBS BILAT
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
2410087
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$738.15 |
| 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 |
$466.20
|
| 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 |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$52.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| 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 |
$707.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| 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 |
$738.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$660.45
|
| 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 |
$722.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$310.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$37.33
|
|
|
XR RIBS BILAT
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
2410087
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$738.15 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$52.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$543.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| Rate for Payer: Multiplan All |
$707.07
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$722.61
|
| Rate for Payer: Zelis Auto |
$310.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.33
|
|
|
XR RIBS BILAT W/CHEST
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
2401110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$913.90 |
| 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 |
$577.20
|
| 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 |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$63.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$769.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| 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 |
$875.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| 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 |
$913.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$817.70
|
| 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 |
$894.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$44.67
|
|
|
XR RIBS BILAT W/CHEST
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
2401110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$63.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$673.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.67
|
|
|
XR RIBS UNILATERAL
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
2465020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$716.30 |
| 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 |
$452.40
|
| 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 |
$452.40
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$640.90
|
| Rate for Payer: First Health Commercial |
$678.60
|
| Rate for Payer: First Health Workers Compensation |
$50.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$678.60
|
| Rate for Payer: GEHA Commercial |
$603.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$678.60
|
| 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 |
$686.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$527.80
|
| Rate for Payer: One Health Plan PPO/POS |
$678.60
|
| 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 |
$716.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$565.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$640.90
|
| 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 |
$701.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$301.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$35.92
|
|
|
XR RIBS UNILATERAL
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
2465020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$640.90
|
| Rate for Payer: First Health Commercial |
$678.60
|
| Rate for Payer: First Health Workers Compensation |
$50.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$678.60
|
| Rate for Payer: GEHA Commercial |
$527.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$678.60
|
| Rate for Payer: Multiplan All |
$686.14
|
| Rate for Payer: OMNI Networks Commercial |
$527.80
|
| Rate for Payer: One Health Plan PPO/POS |
$678.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$716.30
|
| Rate for Payer: Three Rivers Provider Network All |
$565.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$701.22
|
| Rate for Payer: Zelis Auto |
$301.60
|
| Rate for Payer: Zelis Worker's Compensation |
$35.92
|
|
|
XR RIBS UNIV 2 V R OR L
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
8230059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$44.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$121.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.39
|
|
|
XR RIBS UNIV 2 V R OR L
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
8230059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$167.22 |
| 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 |
$104.40
|
| 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 |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$44.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$139.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| 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 |
$158.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| 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 |
$165.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| 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 |
$161.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.39
|
|
|
XR SACRUM/COCCYX 2+ VIEW
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
2400029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$565.25 |
| 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 |
$357.00
|
| 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 |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| 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 |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| 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 |
$565.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$505.75
|
| 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 |
$553.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR SACRUM/COCCYX 2+ VIEW
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
2400029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$416.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR SCAPULA
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
2450034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$340.80
|
| 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 |
$100.97
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: First Health Commercial |
$511.20
|
| Rate for Payer: First Health Workers Compensation |
$37.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.20
|
| Rate for Payer: GEHA Commercial |
$454.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| 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 |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$482.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$26.19
|
|
|
XR SCAPULA
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
2450034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: First Health Commercial |
$511.20
|
| Rate for Payer: First Health Workers Compensation |
$37.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.20
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.19
|
|
|
XR SCAPULA LEFT
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
8230015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$404.60
|
| Rate for Payer: First Health Commercial |
$428.40
|
| Rate for Payer: First Health Workers Compensation |
$37.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$428.40
|
| Rate for Payer: GEHA Commercial |
$333.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$428.40
|
| Rate for Payer: Multiplan All |
$433.16
|
| Rate for Payer: OMNI Networks Commercial |
$333.20
|
| Rate for Payer: One Health Plan PPO/POS |
$428.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$452.20
|
| Rate for Payer: Three Rivers Provider Network All |
$357.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$442.68
|
| Rate for Payer: Zelis Auto |
$190.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.19
|
|
