|
CB MRI CHEST W/WO CONT
|
Facility
|
IP
|
$5,343.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
2100010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$644.86 |
| Max. Negotiated Rate |
$5,075.85 |
| 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 |
$3,740.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,808.70
|
| Rate for Payer: Multiplan All |
$4,862.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,740.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,808.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,075.85
|
| Rate for Payer: Three Rivers Provider Network All |
$4,007.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,968.99
|
| Rate for Payer: Zelis Auto |
$2,137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$644.86
|
|
|
CB MRI C-SPINE W/CONTRAST
|
Facility
|
OP
|
$5,736.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
2172142
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,449.20 |
| 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 |
$3,441.60
|
| 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 |
$3,441.60
|
| Rate for Payer: Cash Price |
$3,441.60
|
| Rate for Payer: Cigna Commercial |
$4,875.60
|
| Rate for Payer: First Health Commercial |
$5,162.40
|
| Rate for Payer: First Health Workers Compensation |
$671.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,162.40
|
| Rate for Payer: GEHA Commercial |
$4,588.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,162.40
|
| 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 |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,219.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,015.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,162.40
|
| 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 |
$5,449.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,302.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,875.60
|
| 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 |
$5,334.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,294.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$474.99
|
|
|
CB MRI C-SPINE W/CONTRAST
|
Facility
|
IP
|
$5,736.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
2172142
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.99 |
| Max. Negotiated Rate |
$5,449.20 |
| Rate for Payer: Cash Price |
$3,441.60
|
| Rate for Payer: Cash Price |
$3,441.60
|
| Rate for Payer: Cigna Commercial |
$4,875.60
|
| Rate for Payer: First Health Commercial |
$5,162.40
|
| Rate for Payer: First Health Workers Compensation |
$671.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,162.40
|
| Rate for Payer: GEHA Commercial |
$4,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,162.40
|
| Rate for Payer: Multiplan All |
$5,219.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,015.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,162.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,449.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,334.48
|
| Rate for Payer: Zelis Auto |
$2,294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$474.99
|
|
|
CB MRI C-SPINE W/O
|
Facility
|
OP
|
$4,378.60
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
2100067
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,159.67 |
| 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 |
$2,627.16
|
| 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 |
$2,627.16
|
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cigna Commercial |
$3,721.81
|
| Rate for Payer: First Health Commercial |
$3,940.74
|
| Rate for Payer: First Health Workers Compensation |
$578.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,940.74
|
| Rate for Payer: GEHA Commercial |
$3,502.88
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,940.74
|
| 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 |
$3,984.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,065.02
|
| Rate for Payer: One Health Plan PPO/POS |
$3,940.74
|
| 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 |
$4,159.67
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,283.95
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,721.81
|
| 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 |
$4,072.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,751.44
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$408.93
|
|
|
CB MRI C-SPINE W/O
|
Facility
|
IP
|
$4,378.60
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
2100067
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$408.93 |
| Max. Negotiated Rate |
$4,159.67 |
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cigna Commercial |
$3,721.81
|
| Rate for Payer: First Health Commercial |
$3,940.74
|
| Rate for Payer: First Health Workers Compensation |
$578.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,940.74
|
| Rate for Payer: GEHA Commercial |
$3,065.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,940.74
|
| Rate for Payer: Multiplan All |
$3,984.53
|
| Rate for Payer: OMNI Networks Commercial |
$3,065.02
|
| Rate for Payer: One Health Plan PPO/POS |
$3,940.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,159.67
|
| Rate for Payer: Three Rivers Provider Network All |
$3,283.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,072.10
|
| Rate for Payer: Zelis Auto |
$1,751.44
|
| Rate for Payer: Zelis Worker's Compensation |
$408.93
|
|
|
CB MRI C-SPINE W/WO
|
Facility
|
IP
|
$5,835.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
2100031
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$584.23 |
| Max. Negotiated Rate |
$5,543.25 |
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cigna Commercial |
$4,959.75
|
| Rate for Payer: First Health Commercial |
$5,251.50
|
| Rate for Payer: First Health Workers Compensation |
$826.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,251.50
|
| Rate for Payer: GEHA Commercial |
$4,084.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,251.50
|
| Rate for Payer: Multiplan All |
$5,309.85
|
| Rate for Payer: OMNI Networks Commercial |
$4,084.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,251.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,543.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,376.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,426.55
|
| Rate for Payer: Zelis Auto |
$2,334.00
|
| Rate for Payer: Zelis Worker's Compensation |
$584.23
|
|
|
CB MRI C-SPINE W/WO
|
Facility
|
OP
|
$5,835.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
2100031
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,543.25 |
| 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 |
$3,501.00
|
| 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 |
$3,501.00
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cigna Commercial |
$4,959.75
|
| Rate for Payer: First Health Commercial |
$5,251.50
|
| Rate for Payer: First Health Workers Compensation |
$826.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,251.50
|
| Rate for Payer: GEHA Commercial |
$4,668.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,251.50
|
| 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 |
$5,309.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,084.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,251.50
|
| 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 |
$5,543.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,376.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,959.75
|
| 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 |
$5,426.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,334.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$584.23
|
|
|
CB MRI LE JNT W/CON
|
Facility
|
IP
|
$5,033.41
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
2173722
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$4,781.74 |
| Rate for Payer: Cash Price |
$3,020.05
|
| Rate for Payer: Cash Price |
$3,020.05
|
| Rate for Payer: Cigna Commercial |
$4,278.40
|
| Rate for Payer: First Health Commercial |
$4,530.07
|
| Rate for Payer: First Health Workers Compensation |
$641.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,530.07
|
| Rate for Payer: GEHA Commercial |
$3,523.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,530.07
|
| Rate for Payer: Multiplan All |
$4,580.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,523.39
|
| Rate for Payer: One Health Plan PPO/POS |
$4,530.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,781.74
|
| Rate for Payer: Three Rivers Provider Network All |
$3,775.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,681.07
|
| Rate for Payer: Zelis Auto |
$2,013.36
|
| Rate for Payer: Zelis Worker's Compensation |
$453.52
|
|
|
CB MRI LE JNT W/CON
|
Facility
|
OP
|
$5,033.41
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
2173722
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$4,781.74 |
| 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 |
$3,020.05
|
| 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 |
$750.19
|
| Rate for Payer: Cash Price |
$3,020.05
|
| Rate for Payer: Cash Price |
$3,020.05
|
| Rate for Payer: Cigna Commercial |
$4,278.40
|
| Rate for Payer: First Health Commercial |
$4,530.07
|
| Rate for Payer: First Health Workers Compensation |
$641.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,530.07
|
| Rate for Payer: GEHA Commercial |
$4,026.73
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,530.07
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$4,580.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$3,523.39
|
| Rate for Payer: One Health Plan PPO/POS |
$4,530.07
|
| 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 |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,781.74
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$3,775.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$4,278.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,681.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$2,013.36
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$453.52
|
|
|
CB MRI LE JNT W/O
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
2100016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,857.00 |
| 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 |
$2,436.00
|
| 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 |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| 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 |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| 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 |
$3,857.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,451.00
|
| 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 |
$3,775.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
CB MRI LE JNT W/O
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
2100016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
CB MRI LE JNT W/WO
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
2100086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$596.14 |
| Max. Negotiated Rate |
$5,097.70 |
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cigna Commercial |
$4,561.10
|
| Rate for Payer: First Health Commercial |
$4,829.40
|
| Rate for Payer: First Health Workers Compensation |
$843.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,829.40
|
| Rate for Payer: GEHA Commercial |
$3,756.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,829.40
|
| Rate for Payer: Multiplan All |
$4,883.06
|
| Rate for Payer: OMNI Networks Commercial |
$3,756.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,829.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,097.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,990.38
|
| Rate for Payer: Zelis Auto |
$2,146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$596.14
|
|
|
CB MRI LE JNT W/WO
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
2100086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,097.70 |
| 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 |
$3,219.60
|
| 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 |
$3,219.60
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cigna Commercial |
$4,561.10
|
| Rate for Payer: First Health Commercial |
$4,829.40
|
| Rate for Payer: First Health Workers Compensation |
$843.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,829.40
|
| Rate for Payer: GEHA Commercial |
$4,292.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,829.40
|
| 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 |
$4,883.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,756.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,829.40
|
| 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 |
$5,097.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,561.10
|
| 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 |
$4,990.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,146.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$596.14
|
|
|
CB MRI LE NON-JT W/CON
|
Facility
|
IP
|
$4,438.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
2173719
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$459.31 |
| Max. Negotiated Rate |
$4,216.10 |
| Rate for Payer: Cash Price |
$2,662.80
|
| Rate for Payer: Cash Price |
$2,662.80
|
| Rate for Payer: Cigna Commercial |
$3,772.30
|
| Rate for Payer: First Health Commercial |
$3,994.20
|
| Rate for Payer: First Health Workers Compensation |
$649.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,994.20
|
| Rate for Payer: GEHA Commercial |
$3,106.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,994.20
|
| Rate for Payer: Multiplan All |
$4,038.58
|
| Rate for Payer: OMNI Networks Commercial |
$3,106.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,994.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,216.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,127.34
|
| Rate for Payer: Zelis Auto |
$1,775.20
|
| Rate for Payer: Zelis Worker's Compensation |
$459.31
|
|
|
CB MRI LE NON-JT W/CON
|
Facility
|
OP
|
$4,438.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
2173719
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,216.10 |
| 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 |
$2,662.80
|
| 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 |
$2,662.80
|
| Rate for Payer: Cash Price |
$2,662.80
|
| Rate for Payer: Cigna Commercial |
$3,772.30
|
| Rate for Payer: First Health Commercial |
$3,994.20
|
| Rate for Payer: First Health Workers Compensation |
$649.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,994.20
|
| Rate for Payer: GEHA Commercial |
$3,550.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,994.20
|
| 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 |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,038.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,106.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,994.20
|
| 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 |
$4,216.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,772.30
|
| 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 |
$4,127.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,775.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$459.31
|
|
|
CB MRI LE NON-JT W/O
|
Facility
|
IP
|
$3,946.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
2100063
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.61 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$2,762.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
|
CB MRI LE NON-JT W/O
|
Facility
|
OP
|
$3,946.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
2100063
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,748.70 |
| 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 |
$2,367.60
|
| 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 |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$3,156.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| 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 |
$3,590.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| 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 |
$3,748.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,354.10
|
| 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 |
$3,669.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
|
CB MRI LE NON-JT W/WO
|
Facility
|
IP
|
$5,201.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
2100064
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$560.65 |
| Max. Negotiated Rate |
$4,940.95 |
| Rate for Payer: Cash Price |
$3,120.60
|
| Rate for Payer: Cash Price |
$3,120.60
|
| Rate for Payer: Cigna Commercial |
$4,420.85
|
| Rate for Payer: First Health Commercial |
$4,680.90
|
| Rate for Payer: First Health Workers Compensation |
$792.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,680.90
|
| Rate for Payer: GEHA Commercial |
$3,640.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,680.90
|
| Rate for Payer: Multiplan All |
$4,732.91
|
| Rate for Payer: OMNI Networks Commercial |
$3,640.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,680.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,940.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,900.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,836.93
|
| Rate for Payer: Zelis Auto |
$2,080.40
|
| Rate for Payer: Zelis Worker's Compensation |
$560.65
|
|
|
CB MRI LE NON-JT W/WO
|
Facility
|
OP
|
$5,201.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
2100064
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,940.95 |
| 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 |
$3,120.60
|
| 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 |
$3,120.60
|
| Rate for Payer: Cash Price |
$3,120.60
|
| Rate for Payer: Cigna Commercial |
$4,420.85
|
| Rate for Payer: First Health Commercial |
$4,680.90
|
| Rate for Payer: First Health Workers Compensation |
$792.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,680.90
|
| Rate for Payer: GEHA Commercial |
$4,160.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,680.90
|
| 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 |
$4,732.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,640.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,680.90
|
| 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 |
$4,940.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,900.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,420.85
|
| 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 |
$4,836.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,080.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$560.65
|
|
|
CB MRI L-SPINE W/CON
|
Facility
|
IP
|
$4,844.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
2172149
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$467.80 |
| Max. Negotiated Rate |
$4,601.80 |
| Rate for Payer: Cash Price |
$2,906.40
|
| Rate for Payer: Cash Price |
$2,906.40
|
| Rate for Payer: Cigna Commercial |
$4,117.40
|
| Rate for Payer: First Health Commercial |
$4,359.60
|
| Rate for Payer: First Health Workers Compensation |
$661.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,359.60
|
| Rate for Payer: GEHA Commercial |
$3,390.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,359.60
|
| Rate for Payer: Multiplan All |
$4,408.04
|
| Rate for Payer: OMNI Networks Commercial |
$3,390.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,359.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,601.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,633.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,504.92
|
| Rate for Payer: Zelis Auto |
$1,937.60
|
| Rate for Payer: Zelis Worker's Compensation |
$467.80
|
|
|
CB MRI L-SPINE W/CON
|
Facility
|
OP
|
$4,844.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
2172149
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,601.80 |
| 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 |
$2,906.40
|
| 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 |
$2,906.40
|
| Rate for Payer: Cash Price |
$2,906.40
|
| Rate for Payer: Cigna Commercial |
$4,117.40
|
| Rate for Payer: First Health Commercial |
$4,359.60
|
| Rate for Payer: First Health Workers Compensation |
$661.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,359.60
|
| Rate for Payer: GEHA Commercial |
$3,875.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,359.60
|
| 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 |
$4,408.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,390.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,359.60
|
| 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 |
$4,601.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,633.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,117.40
|
| 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 |
$4,504.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,937.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$467.80
|
|
|
CB MRI L-SPINE W/O
|
Facility
|
IP
|
$4,372.30
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
2100032
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$405.74 |
| Max. Negotiated Rate |
$4,153.69 |
| Rate for Payer: Cash Price |
$2,623.38
|
| Rate for Payer: Cash Price |
$2,623.38
|
| Rate for Payer: Cigna Commercial |
$3,716.45
|
| Rate for Payer: First Health Commercial |
$3,935.07
|
| Rate for Payer: First Health Workers Compensation |
$573.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,935.07
|
| Rate for Payer: GEHA Commercial |
$3,060.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,935.07
|
| Rate for Payer: Multiplan All |
$3,978.79
|
| Rate for Payer: OMNI Networks Commercial |
$3,060.61
|
| Rate for Payer: One Health Plan PPO/POS |
$3,935.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,153.69
|
| Rate for Payer: Three Rivers Provider Network All |
$3,279.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,066.24
|
| Rate for Payer: Zelis Auto |
$1,748.92
|
| Rate for Payer: Zelis Worker's Compensation |
$405.74
|
|
|
CB MRI L-SPINE W/O
|
Facility
|
OP
|
$4,372.30
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
2100032
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,153.69 |
| 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 |
$2,623.38
|
| 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 |
$2,623.38
|
| Rate for Payer: Cash Price |
$2,623.38
|
| Rate for Payer: Cigna Commercial |
$3,716.45
|
| Rate for Payer: First Health Commercial |
$3,935.07
|
| Rate for Payer: First Health Workers Compensation |
$573.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,935.07
|
| Rate for Payer: GEHA Commercial |
$3,497.84
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,935.07
|
| 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 |
$3,978.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,060.61
|
| Rate for Payer: One Health Plan PPO/POS |
$3,935.07
|
| 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 |
$4,153.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,279.22
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,716.45
|
| 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 |
$4,066.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,748.92
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$405.74
|
|
|
CB MRI L-SPINE W/WO
|
Facility
|
OP
|
$5,907.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
2100033
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,611.65 |
| 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 |
$3,544.20
|
| 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 |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cigna Commercial |
$5,020.95
|
| Rate for Payer: First Health Commercial |
$5,316.30
|
| Rate for Payer: First Health Workers Compensation |
$818.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,316.30
|
| Rate for Payer: GEHA Commercial |
$4,725.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,316.30
|
| 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 |
$5,375.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,134.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,316.30
|
| 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 |
$5,611.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,430.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,020.95
|
| 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 |
$5,493.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,362.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$578.83
|
|
|
CB MRI L-SPINE W/WO
|
Facility
|
IP
|
$5,907.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
2100033
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$578.83 |
| Max. Negotiated Rate |
$5,611.65 |
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cigna Commercial |
$5,020.95
|
| Rate for Payer: First Health Commercial |
$5,316.30
|
| Rate for Payer: First Health Workers Compensation |
$818.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,316.30
|
| Rate for Payer: GEHA Commercial |
$4,134.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,316.30
|
| Rate for Payer: Multiplan All |
$5,375.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,134.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,316.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,611.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,430.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,493.51
|
| Rate for Payer: Zelis Auto |
$2,362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$578.83
|
|
