|
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
|
|
|
XR TM JOINTS
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
2400330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$602.30 |
| 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 |
$380.40
|
| 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 |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$63.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$507.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| 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 |
$576.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| 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 |
$602.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$538.90
|
| 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 |
$589.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$44.98
|
|
|
XR TM JOINTS
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
2400330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: First Health Workers Compensation |
$63.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$443.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.98
|
|
|
XR TOES
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2450053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$433.20 |
| 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 |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$410.40
|
| Rate for Payer: GEHA Commercial |
$364.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$410.40
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$414.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$319.20
|
| Rate for Payer: One Health Plan PPO/POS |
$410.40
|
| 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 |
$433.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$342.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$387.60
|
| 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 |
$424.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$182.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
XR TOES
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2450053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$410.40
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$410.40
|
| Rate for Payer: Multiplan All |
$414.96
|
| Rate for Payer: OMNI Networks Commercial |
$319.20
|
| Rate for Payer: One Health Plan PPO/POS |
$410.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$433.20
|
| Rate for Payer: Three Rivers Provider Network All |
$342.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.08
|
| Rate for Payer: Zelis Auto |
$182.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
XR TOES LEFT
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
8230045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| 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 |
$189.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$252.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| 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 |
$300.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$268.60
|
| 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 |
$293.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
XR TOES LEFT
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
8230045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$221.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
XR TOES RIGHT
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
8250024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$221.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
XR TOES RIGHT
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
8250024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| 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 |
$189.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$252.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| 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 |
$300.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$268.60
|
| 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 |
$293.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
XR T-SPINE 2V
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
2400022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$596.60 |
| 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 |
$376.80
|
| 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 |
$100.97
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$533.80
|
| Rate for Payer: First Health Commercial |
$565.20
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$565.20
|
| Rate for Payer: GEHA Commercial |
$502.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$565.20
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$571.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$439.60
|
| Rate for Payer: One Health Plan PPO/POS |
$565.20
|
| 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 |
$596.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$471.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$533.80
|
| 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 |
$584.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$251.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
XR T-SPINE 2V
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
2400022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$596.60 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$533.80
|
| Rate for Payer: First Health Commercial |
$565.20
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$565.20
|
| Rate for Payer: GEHA Commercial |
$439.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$565.20
|
| Rate for Payer: Multiplan All |
$571.48
|
| Rate for Payer: OMNI Networks Commercial |
$439.60
|
| Rate for Payer: One Health Plan PPO/POS |
$565.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$596.60
|
| Rate for Payer: Three Rivers Provider Network All |
$471.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.04
|
| Rate for Payer: Zelis Auto |
$251.20
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
XR T-SPINE 3V
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
2400227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$697.30 |
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$623.90
|
| Rate for Payer: First Health Commercial |
$660.60
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$660.60
|
| Rate for Payer: GEHA Commercial |
$513.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$660.60
|
| Rate for Payer: Multiplan All |
$667.94
|
| Rate for Payer: OMNI Networks Commercial |
$513.80
|
| Rate for Payer: One Health Plan PPO/POS |
$660.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$697.30
|
| Rate for Payer: Three Rivers Provider Network All |
$550.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$682.62
|
| Rate for Payer: Zelis Auto |
$293.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
XR T-SPINE 3V
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
2400227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$697.30 |
| 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 |
$440.40
|
| 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 |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$623.90
|
| Rate for Payer: First Health Commercial |
$660.60
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$660.60
|
| Rate for Payer: GEHA Commercial |
$587.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$660.60
|
| 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 |
$667.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$513.80
|
| Rate for Payer: One Health Plan PPO/POS |
$660.60
|
| 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 |
$697.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$550.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$623.90
|
| 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 |
$682.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$293.60
|
| 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 WRIST 2V
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
2450082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$483.55 |
| 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 |
$305.40
|
| 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 |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| 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 |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| 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 |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$432.65
|
| 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 |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
XR WRIST 2V
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
2450082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
XR WRIST AP LAT LEFT
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
8230024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
XR WRIST AP LAT LEFT
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
8230024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| 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 |
$193.80
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| 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 |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| 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 |
$306.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| 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 |
$300.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
XR WRIST AP/LAT RIGHT
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
8250009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
XR WRIST AP/LAT RIGHT
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
8250009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| 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 |
$193.80
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| 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 |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| 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 |
$306.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| 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 |
$300.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
XR WRIST COMP
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
2450042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$435.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
XR WRIST COMP
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
2450042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$590.90 |
| 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 |
$373.20
|
| 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 |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$497.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| 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 |
$566.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| 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 |
$590.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$528.70
|
| 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 |
$578.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
XR WRIST COMP LEFT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
8230025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| 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 |
$49.18
|
| 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 |
$34.78
|
|
|
XR WRIST COMP LEFT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
8230025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| 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 |
$49.18
|
| 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 |
$34.78
|
|
|
XR WRIST COMP RIGHT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
8250010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| 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 |
$49.18
|
| 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 |
$34.78
|
|
|
XR WRIST COMP RIGHT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
8250010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| 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 |
$49.18
|
| 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 |
$34.78
|
|
