Commercial healthcare reimbursement in New Mexico
How New Mexico compares with the nation, by payer, specialty and procedure.
New Mexico at a glance
What the data shows
New Mexico ranks 33rd of 51 states for commercial reimbursement, with an index of 94 (100 = national median) across 228 procedure codes; the West region averages 118.
Commercial rates in New Mexico run a median 141% of Medicare.
UnitedHealthcare has the highest index in the state (132) and Blue Cross Blue Shield the lowest (74), a 58-point gap, in the files analyzed.
CPT 67042 (Vit for macular hole) is the strongest relative to the national median (133% of it, a 33% premium); CPT 88312 (Special stains group 1) is furthest below (69% of the national median, 31% lower).
By specialty, New Mexico is strongest for ophthalmology (ranks 20th of 50 states for that specialty) and weakest for diagnostic radiology (42nd of 51).
Against Medicare, gastroenterology has the highest ratio in New Mexico (191% of Medicare) and dermatology the lowest (91%).
Payer ranking in New Mexico
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 132 | 1 | 228 | 471 | 329 | |
| Cigna | 112 | 2 | 227 | 464 | 357 | |
| Aetna | 94 | 3 | 205 | 406 | 313 | |
| Blue Cross Blue Shield | 74 | 4 | 227 | 562 | 465 |
Reimbursement index by specialty in New Mexico
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Ophthalmology | 110 | 20 of 50 | 131% | 42 | 74 | |
| Internal medicine | 100 | 24 of 51 | 114% | 25 | 106 | |
| Gastroenterology | 98 | 24 of 50 | 191% | 36 | 58 | |
| Dermatology | 94 | 32 of 50 | 91% | 44 | 34 | |
| Cardiology | 93 | 34 of 51 | 134% | 38 | 85 | |
| Orthopedic surgery | 92 | 36 of 51 | 133% | 39 | 106 | |
| Urology | 91 | 37 of 50 | 138% | 37 | 34 | |
| Diagnostic radiology | 90 | 42 of 51 | 138% | 49 | 125 |
Specialty by payer in New Mexico
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 137 | 78 | 112 | 80 |
| Dermatology | 161 | 83 | 112 | 83 |
| Ophthalmology | 160 | 98 | 111 | 81 |
| Cardiology | 115 | 85 | 106 | 72 |
| Orthopedic surgery | 108 | 87 | 105 | 75 |
| Diagnostic radiology | 113 | 87 | 109 | 35 |
| Urology | 137 | 78 | 101 | 74 |
| Gastroenterology | 137 | 81 | 105 | 74 |
New Mexico compared with West region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| New Mexico | 94 | 33 | 141% | 622 | |
| California | 93 | 35 | 138% | 844 | |
| Utah | 100 | 25 | 154% | 818 | |
| Montana | 100 | 24 | 160% | 448 | |
| Nevada | 87 | 43 | 128% | 780 | |
| Hawaii | 102 | 21 | 138% | 524 |
Procedures that pay most and least in New Mexico vs the nation
Highest vs national
| Code | New Mexico | National | Gap | Prov. |
|---|---|---|---|---|
| 67042 Vit for macular hole | $1,992 | $1,494 | +33% | 73 |
| 66982 Xcapsl ctrc rmvl cplx wo ecp | $1,283 | $981 | +31% | 74 |
| 67108 Repair detached retina | $2,052 | $1,594 | +29% | 73 |
| 65778 Cover eye w/membrane | $85 | $70 | +22% | 73 |
| 92083 Extended visual field xm | $88 | $73 | +21% | 74 |
| 67210 Treatment of retinal lesion | $778 | $659 | +18% | 71 |
| 65855 Trabeculoplasty laser surg | $362 | $307 | +18% | 73 |
| 92134 Cptrz oph dx img pst sgm rta | $53 | $45 | +17% | 73 |
| 92133 Cptrzd oph dx img pst sgm on | $50 | $42 | +17% | 73 |
| 92025 Cptrized corneal topography | $47 | $40 | +16% | 73 |
| 66984 Xcapsl ctrc rmvl w/o ecp | $852 | $738 | +16% | 74 |
| 92201 Opscpy extnd rta draw uni/bi | $30 | $27 | +15% | 72 |
| 67036 Removal of inner eye fluid | $1,274 | $1,117 | +14% | 73 |
| 92202 Opscpy extnd on/mac draw | $19 | $17 | +14% | 72 |
| 65756 Corneal trnspl endothelial | $1,600 | $1,425 | +12% | 73 |
Lowest vs national
| Code | New Mexico | National | Gap | Prov. |
|---|---|---|---|---|
| 88312 Special stains group 1 | $68 | $97 | -31% | 92 |
| 73630 X-ray exam of foot | $33 | $44 | -25% | 103 |
| 88313 Special stains group 2 | $53 | $71 | -25% | 58 |
| 88342 Imhchem/imcytchm 1st antb | $72 | $95 | -24% | 34 |
| 52332 Cystoscopy and treatment | $276 | $360 | -23% | 33 |
| 72110 X-ray exam l-2 spine 4/>vws | $54 | $71 | -23% | 103 |
| 73562 X-ray exam of knee 3 | $41 | $53 | -23% | 104 |
| 73610 X-ray exam of ankle | $36 | $47 | -23% | 104 |
| 51702 Insert temp bladder cath | $47 | $61 | -23% | 34 |
| 72100 X-ray exam l-s spine 2/3 vws | $41 | $53 | -23% | 104 |
| 76775 Us exam abdo back wall lim | $72 | $92 | -23% | 34 |
| 43239 Egd biopsy single/multiple | $271 | $349 | -22% | 58 |
| 73564 X-ray exam knee 4 or more | $47 | $60 | -21% | 104 |
| 73560 X-ray exam of knee 1 or 2 | $35 | $45 | -21% | 104 |
| 43235 Egd diagnostic brush wash | $231 | $294 | -21% | 58 |
Frequently asked questions
How do commercial reimbursement rates in New Mexico compare with the rest of the country?
New Mexico ranks 33rd of 51 states with an index of 94, across 228 procedure codes. Median commercial rates run 141% of the Medicare rate.
Which payer has the highest rates in New Mexico?
In the files we analyzed, UnitedHealthcare has the highest index (132) and Blue Cross Blue Shield the lowest (74). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in New Mexico?
Ophthalmology ranks 20th of 50 states.
How many providers does this New Mexico page cover?
622 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between New Mexico and the national median?
CPT 67042 (Vit for macular hole) is highest relative to the nation at 133% of the national median; CPT 88312 (Special stains group 1) is lowest at 69%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your New Mexico contracts
Compare your negotiated rates with these state medians by payer and specialty.