|
CB MRA HEAD W/O
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
2100082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,329.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$3,300.55
|
| Rate for Payer: First Health Commercial |
$3,494.70
|
| Rate for Payer: First Health Workers Compensation |
$591.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,494.70
|
| Rate for Payer: GEHA Commercial |
$3,106.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,494.70
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,533.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,718.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,494.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,688.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,912.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,300.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,611.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,553.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$417.91
|
|
|
CB MRA HEAD W/O
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
2100082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$417.91 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$3,300.55
|
| Rate for Payer: First Health Commercial |
$3,494.70
|
| Rate for Payer: First Health Workers Compensation |
$591.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,494.70
|
| Rate for Payer: GEHA Commercial |
$2,718.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,494.70
|
| Rate for Payer: Multiplan All |
$3,533.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,718.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,494.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,688.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,912.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,611.19
|
| Rate for Payer: Zelis Auto |
$1,553.20
|
| Rate for Payer: Zelis Worker's Compensation |
$417.91
|
|
|
CB MRA HEAD W/WO CONT
|
Facility
|
OP
|
$5,408.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
2170546
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,137.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,244.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cigna Commercial |
$4,596.80
|
| Rate for Payer: First Health Commercial |
$4,867.20
|
| Rate for Payer: First Health Workers Compensation |
$961.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,867.20
|
| Rate for Payer: GEHA Commercial |
$4,326.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,867.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,921.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,785.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,867.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,137.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,056.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,596.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,029.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,163.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$679.85
|
|
|
CB MRA HEAD W/WO CONT
|
Facility
|
IP
|
$5,408.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
2170546
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$679.85 |
| Max. Negotiated Rate |
$5,137.60 |
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cigna Commercial |
$4,596.80
|
| Rate for Payer: First Health Commercial |
$4,867.20
|
| Rate for Payer: First Health Workers Compensation |
$961.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,867.20
|
| Rate for Payer: GEHA Commercial |
$3,785.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,867.20
|
| Rate for Payer: Multiplan All |
$4,921.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,785.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,867.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,137.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,056.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,029.44
|
| Rate for Payer: Zelis Auto |
$2,163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$679.85
|
|
|
CB MRA/MRV HEAD W/WO CON
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
2100083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cigna Commercial |
$4,421.70
|
| Rate for Payer: First Health Commercial |
$4,681.80
|
| Rate for Payer: First Health Workers Compensation |
$961.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,681.80
|
| Rate for Payer: GEHA Commercial |
$4,161.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,681.80
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,733.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,641.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,681.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,941.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,901.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,421.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,837.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,080.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$679.85
|
|
|
CB MRA/MRV HEAD W/WO CON
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
2100083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$679.85 |
| Max. Negotiated Rate |
$4,941.90 |
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cigna Commercial |
$4,421.70
|
| Rate for Payer: First Health Commercial |
$4,681.80
|
| Rate for Payer: First Health Workers Compensation |
$961.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,681.80
|
| Rate for Payer: GEHA Commercial |
$3,641.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,681.80
|
| Rate for Payer: Multiplan All |
$4,733.82
|
| Rate for Payer: OMNI Networks Commercial |
$3,641.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,681.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,941.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,901.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,837.86
|
| Rate for Payer: Zelis Auto |
$2,080.80
|
| Rate for Payer: Zelis Worker's Compensation |
$679.85
|
|
|
CB MRA NECK W/O CONTRST MATERIAL
|
Facility
|
OP
|
$3,820.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
2170547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,292.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,247.00
|
| Rate for Payer: First Health Commercial |
$3,438.00
|
| Rate for Payer: First Health Workers Compensation |
$580.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.00
|
| Rate for Payer: GEHA Commercial |
$3,056.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,476.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,247.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,552.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,528.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$410.33
|
|
|
CB MRA NECK W/O CONTRST MATERIAL
|
Facility
|
IP
|
$3,820.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
2170547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$410.33 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,247.00
|
| Rate for Payer: First Health Commercial |
$3,438.00
|
| Rate for Payer: First Health Workers Compensation |
$580.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.00
|
| Rate for Payer: GEHA Commercial |
$2,674.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.00
|
| Rate for Payer: Multiplan All |
$3,476.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,552.60
|
| Rate for Payer: Zelis Auto |
$1,528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$410.33
|
|
|
CB MRI ABD W/O
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
2100001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,895.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,460.00
|
| Rate for Payer: Cash Price |
$2,460.00
|
| Rate for Payer: Cigna Commercial |
$3,485.00
|
| Rate for Payer: First Health Commercial |
$3,690.00
|
| Rate for Payer: First Health Workers Compensation |
$555.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,690.00
|
| Rate for Payer: GEHA Commercial |
$3,280.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,690.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,731.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,870.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,690.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,895.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,075.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,485.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,813.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,640.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$393.06
|
|
|
CB MRI ABD W/O
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
2100001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$393.06 |
| Max. Negotiated Rate |
$3,895.00 |
| Rate for Payer: Cash Price |
$2,460.00
|
| Rate for Payer: Cash Price |
$2,460.00
|
| Rate for Payer: Cigna Commercial |
$3,485.00
|
| Rate for Payer: First Health Commercial |
$3,690.00
|
| Rate for Payer: First Health Workers Compensation |
$555.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,690.00
|
| Rate for Payer: GEHA Commercial |
$2,870.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,690.00
|
| Rate for Payer: Multiplan All |
$3,731.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,870.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,690.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,895.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,075.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,813.00
|
| Rate for Payer: Zelis Auto |
$1,640.00
|
| Rate for Payer: Zelis Worker's Compensation |
$393.06
|
|
|
CB MRI ABD W/WO
|
Facility
|
IP
|
$5,576.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
2100002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.91 |
| Max. Negotiated Rate |
$5,297.20 |
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cigna Commercial |
$4,739.60
|
| Rate for Payer: First Health Commercial |
$5,018.40
|
| Rate for Payer: First Health Workers Compensation |
$878.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,018.40
|
| Rate for Payer: GEHA Commercial |
$3,903.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,018.40
|
| Rate for Payer: Multiplan All |
$5,074.16
|
| Rate for Payer: OMNI Networks Commercial |
$3,903.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,018.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,297.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,182.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,185.68
|
| Rate for Payer: Zelis Auto |
$2,230.40
|
| Rate for Payer: Zelis Worker's Compensation |
$620.91
|
|
|
CB MRI ABD W/WO
|
Facility
|
OP
|
$5,576.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
2100002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,297.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,345.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cigna Commercial |
$4,739.60
|
| Rate for Payer: First Health Commercial |
$5,018.40
|
| Rate for Payer: First Health Workers Compensation |
$878.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,018.40
|
| Rate for Payer: GEHA Commercial |
$4,460.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,018.40
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,074.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,903.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,018.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,297.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,182.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,739.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,185.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,230.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$620.91
|
|
|
CB MRI BRAIN W/CON
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
2100090
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,497.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,840.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cigna Commercial |
$4,023.90
|
| Rate for Payer: First Health Commercial |
$4,260.60
|
| Rate for Payer: First Health Workers Compensation |
$664.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,260.60
|
| Rate for Payer: GEHA Commercial |
$3,787.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,260.60
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,307.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,313.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,260.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,497.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,550.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,023.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,402.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,893.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$470.08
|
|
|
CB MRI BRAIN W/CON
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
2100090
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$470.08 |
| Max. Negotiated Rate |
$4,497.30 |
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cigna Commercial |
$4,023.90
|
| Rate for Payer: First Health Commercial |
$4,260.60
|
| Rate for Payer: First Health Workers Compensation |
$664.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,260.60
|
| Rate for Payer: GEHA Commercial |
$3,313.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,260.60
|
| Rate for Payer: Multiplan All |
$4,307.94
|
| Rate for Payer: OMNI Networks Commercial |
$3,313.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,260.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,497.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,550.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,402.62
|
| Rate for Payer: Zelis Auto |
$1,893.60
|
| Rate for Payer: Zelis Worker's Compensation |
$470.08
|
|
|
CB MRI BRAIN W/O
|
Facility
|
IP
|
$4,331.50
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
2100004
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$411.17 |
| Max. Negotiated Rate |
$4,114.93 |
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cigna Commercial |
$3,681.78
|
| Rate for Payer: First Health Commercial |
$3,898.35
|
| Rate for Payer: First Health Workers Compensation |
$581.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,898.35
|
| Rate for Payer: GEHA Commercial |
$3,032.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,898.35
|
| Rate for Payer: Multiplan All |
$3,941.66
|
| Rate for Payer: OMNI Networks Commercial |
$3,032.05
|
| Rate for Payer: One Health Plan PPO/POS |
$3,898.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,114.93
|
| Rate for Payer: Three Rivers Provider Network All |
$3,248.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,028.30
|
| Rate for Payer: Zelis Auto |
$1,732.60
|
| Rate for Payer: Zelis Worker's Compensation |
$411.17
|
|
|
CB MRI BRAIN W/O
|
Facility
|
OP
|
$4,331.50
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
2100004
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,114.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,598.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cigna Commercial |
$3,681.78
|
| Rate for Payer: First Health Commercial |
$3,898.35
|
| Rate for Payer: First Health Workers Compensation |
$581.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,898.35
|
| Rate for Payer: GEHA Commercial |
$3,465.20
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,898.35
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,941.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,032.05
|
| Rate for Payer: One Health Plan PPO/POS |
$3,898.35
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,114.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,248.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,681.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,028.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,732.60
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$411.17
|
|
|
CB MRI BRAIN W/WO
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
2100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: First Health Workers Compensation |
$824.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,800.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$582.86
|
|
|
CB MRI BRAIN W/WO
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
2100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$582.86 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: First Health Workers Compensation |
$824.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
| Rate for Payer: Zelis Worker's Compensation |
$582.86
|
|
|
CB MRI BREAST C- BILATERAL
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
2100084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,238.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,677.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cigna Commercial |
$3,792.70
|
| Rate for Payer: First Health Commercial |
$4,015.80
|
| Rate for Payer: First Health Workers Compensation |
$329.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,015.80
|
| Rate for Payer: GEHA Commercial |
$3,569.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,015.80
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$4,060.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,123.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,015.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$322.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,238.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,346.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,792.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,149.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,784.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$232.95
|
|
|
CB MRI BREAST C- BILATERAL
|
Facility
|
IP
|
$4,462.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
2100084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$232.95 |
| Max. Negotiated Rate |
$4,238.90 |
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cigna Commercial |
$3,792.70
|
| Rate for Payer: First Health Commercial |
$4,015.80
|
| Rate for Payer: First Health Workers Compensation |
$329.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,015.80
|
| Rate for Payer: GEHA Commercial |
$3,123.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,015.80
|
| Rate for Payer: Multiplan All |
$4,060.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,123.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,015.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,238.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,149.66
|
| Rate for Payer: Zelis Auto |
$1,784.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.95
|
|
|
CB MRI BREAST C-+ W/CAD BILATERAL
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
2100085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$368.06 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$520.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,743.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Humana ChoiceCare |
$891.54
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,057.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.52
|
| Rate for Payer: United Healthcare Commercial |
$2,914.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.50
|
| Rate for Payer: Zelis Worker's Compensation |
$368.06
|
|
|
CB MRI BREAST C-+ W/CAD BILATERAL
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
2100085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$368.06 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$520.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,400.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$368.06
|
|
|
CB MRI CHEST W/O CONTRST
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
2100009
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$430.58 |
| Max. Negotiated Rate |
$3,686.95 |
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cigna Commercial |
$3,298.85
|
| Rate for Payer: First Health Commercial |
$3,492.90
|
| Rate for Payer: First Health Workers Compensation |
$608.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,492.90
|
| Rate for Payer: GEHA Commercial |
$2,716.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,492.90
|
| Rate for Payer: Multiplan All |
$3,531.71
|
| Rate for Payer: OMNI Networks Commercial |
$2,716.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,492.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,686.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,910.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,609.33
|
| Rate for Payer: Zelis Auto |
$1,552.40
|
| Rate for Payer: Zelis Worker's Compensation |
$430.58
|
|
|
CB MRI CHEST W/O CONTRST
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
2100009
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,686.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cigna Commercial |
$3,298.85
|
| Rate for Payer: First Health Commercial |
$3,492.90
|
| Rate for Payer: First Health Workers Compensation |
$608.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,492.90
|
| Rate for Payer: GEHA Commercial |
$3,104.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,492.90
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,531.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,716.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,492.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,686.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,910.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,609.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,552.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$430.58
|
|
|
CB MRI CHEST W/WO CONT
|
Facility
|
OP
|
$5,343.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
2100010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,075.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,205.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna Commercial |
$4,541.55
|
| Rate for Payer: First Health Commercial |
$4,808.70
|
| Rate for Payer: First Health Workers Compensation |
$912.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,808.70
|
| Rate for Payer: GEHA Commercial |
$4,274.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,808.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,862.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,740.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,808.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,075.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,007.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,541.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,968.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,137.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$644.86
|
|
