|
XR SI JOINTS 3+VWS
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
2400028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$554.80 |
| 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 |
$350.40
|
| 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 |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| 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 |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| 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 |
$554.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$496.40
|
| 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 |
$543.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
XR SI JOINTS 3+VWS
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
2400028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
XR SINUSES <3V
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
2400006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$419.90 |
| 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 |
$265.20
|
| 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 |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| 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 |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| 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 |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$375.70
|
| 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 |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR SINUSES <3V
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
2400006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR SINUSES 3+VWS
|
Facility
|
IP
|
$713.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
2400007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$677.35 |
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$606.05
|
| Rate for Payer: First Health Commercial |
$641.70
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$641.70
|
| Rate for Payer: GEHA Commercial |
$499.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$641.70
|
| Rate for Payer: Multiplan All |
$648.83
|
| Rate for Payer: OMNI Networks Commercial |
$499.10
|
| Rate for Payer: One Health Plan PPO/POS |
$641.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$677.35
|
| Rate for Payer: Three Rivers Provider Network All |
$534.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$663.09
|
| Rate for Payer: Zelis Auto |
$285.20
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
XR SINUSES 3+VWS
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
2400007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$677.35 |
| 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 |
$427.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$606.05
|
| Rate for Payer: First Health Commercial |
$641.70
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$641.70
|
| Rate for Payer: GEHA Commercial |
$570.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$641.70
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$648.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$499.10
|
| Rate for Payer: One Health Plan PPO/POS |
$641.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$677.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$534.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$606.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$663.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$285.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
XR SITZ MARKER STUDY
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
2400363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$45.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$476.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$143.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$506.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$32.39
|
|
|
XR SITZ MARKER STUDY
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
2400363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$45.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$417.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.39
|
|
|
XR SKULL 4+VWS
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
2400009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$770.45 |
| 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 |
$486.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$689.35
|
| Rate for Payer: First Health Commercial |
$729.90
|
| Rate for Payer: First Health Workers Compensation |
$55.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$729.90
|
| Rate for Payer: GEHA Commercial |
$648.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$729.90
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$738.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$567.70
|
| Rate for Payer: One Health Plan PPO/POS |
$729.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$770.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$608.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$689.35
|
| 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 |
$754.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$324.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$39.19
|
|
|
XR SKULL 4+VWS
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
2400009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$689.35
|
| Rate for Payer: First Health Commercial |
$729.90
|
| Rate for Payer: First Health Workers Compensation |
$55.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$729.90
|
| Rate for Payer: GEHA Commercial |
$567.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$729.90
|
| Rate for Payer: Multiplan All |
$738.01
|
| Rate for Payer: OMNI Networks Commercial |
$567.70
|
| Rate for Payer: One Health Plan PPO/POS |
$729.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$770.45
|
| Rate for Payer: Three Rivers Provider Network All |
$608.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$754.23
|
| Rate for Payer: Zelis Auto |
$324.40
|
| Rate for Payer: Zelis Worker's Compensation |
$39.19
|
|
|
XR SMALL BOWEL FOLLOW THROUGH
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
2474248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.45 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$109.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Worker's Compensation |
$77.45
|
|
|
XR SMALL BOWEL FOLLOW THROUGH
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
2474248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$109.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Commercial |
$204.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
| Rate for Payer: Zelis Worker's Compensation |
$77.45
|
|
|
XR SOFT TISSUE NECK
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
2400360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$497.80 |
| 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 |
$314.40
|
| 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 |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: First Health Workers Compensation |
$37.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$419.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| 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 |
$476.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| 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 |
$497.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$445.40
|
| 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 |
$487.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$209.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$26.86
|
|
|
XR SOFT TISSUE NECK
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
2400360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$497.80 |
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: First Health Workers Compensation |
$37.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$366.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: Zelis Auto |
$209.60
|
| Rate for Payer: Zelis Worker's Compensation |
$26.86
|
|
|
XR STERNUM 2+VWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
2400018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$544.35 |
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$487.05
|
| Rate for Payer: First Health Commercial |
$515.70
|
| Rate for Payer: First Health Workers Compensation |
$40.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$515.70
|
| Rate for Payer: GEHA Commercial |
$401.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$515.70
|
| Rate for Payer: Multiplan All |
$521.43
|
| Rate for Payer: OMNI Networks Commercial |
$401.10
|
| Rate for Payer: One Health Plan PPO/POS |
$515.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$544.35
|
| Rate for Payer: Three Rivers Provider Network All |
$429.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$532.89
|
| Rate for Payer: Zelis Auto |
$229.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
XR STERNUM 2+VWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
2400018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$544.35 |
| 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 |
$343.80
|
| 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 |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$487.05
|
| Rate for Payer: First Health Commercial |
$515.70
|
| Rate for Payer: First Health Workers Compensation |
$40.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$515.70
|
| Rate for Payer: GEHA Commercial |
$458.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$515.70
|
| 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 |
$521.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$401.10
|
| Rate for Payer: One Health Plan PPO/POS |
$515.70
|
| 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 |
$544.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$429.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$487.05
|
| 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 |
$532.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$229.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$28.55
|
|
|
XR ST MOD BARIUM SWALL
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
2400205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
XR ST MOD BARIUM SWALL
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
2400205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.53
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Humana ChoiceCare |
$190.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$438.60
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$119.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$103.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$643.28
|
| Rate for Payer: United Healthcare Commercial |
$621.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$365.50
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
XR TIB/FIB
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
2450050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$399.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| Rate for Payer: Multiplan All |
$518.70
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$541.50
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$530.10
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
XR TIB/FIB
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
2450050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$541.50 |
| 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 |
$342.00
|
| 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 |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.00
|
| Rate for Payer: GEHA Commercial |
$456.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.00
|
| 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 |
$518.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$399.00
|
| Rate for Payer: One Health Plan PPO/POS |
$513.00
|
| 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 |
$541.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$427.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$484.50
|
| 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 |
$530.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$228.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
XR TIBIA/FIBULA LEFT
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
8230038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
XR TIBIA/FIBULA LEFT
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
8230038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| 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 |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$393.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
XR TIBIA/FIBULA RIGHT
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
8250018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
XR TIBIA/FIBULA RIGHT
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
8250018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$37.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| 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 |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$393.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$26.85
|
|
|
XR T-L SPINE 2 VIEWS
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
2400226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$567.15 |
| 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 |
$358.20
|
| 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 |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$41.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| 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 |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$507.45
|
| 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 |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
